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Cancer, also called malignancy or neoplasm, develops when cells in a specific part of the body begin to grow out of control. Unlike normal cells, cancer cells do not stop reproducing after they have doubled 50-60 times.

Normal body cells grow, divide, and die in an orderly, natural fashion. Normal cells divide more rapidly during the early years of an individual's life. After adulthood is reached, cells in most parts of the body divide only to replace worn-out or dying cells and to repair injuries. Cancer cells continue to grow and divide, forming new abnormal cells.

Cancer cells usually form a tumor. Some cancers, such as leukemia or cancer of the bone marrow and blood, do not form tumors. Instead, these cancer cells circulate through other tissues, where they grow.

Not all tumors are cancerous. Benign (noncancerous) tumors do not metastasize (spread) to other parts of the body and, with very rare exceptions, are not life threatening. Different types of cancer can grow at different rates and respond to different treatments. Malignant, or cancerous, tumors may metastasize and cause further damage to organs and tissues in the body.

Cancer cells develop because of damage to DNA (the material inside the nucleus of a cell that carries genetic information). DNA occurs in most cells of the body and is the blueprint for how the body grows, functions, and stays healthy. Usually, when DNA becomes damaged, the body is able to repair it. In cancer cells, the damaged DNA is not able to be repaired. Individuals can inherit damaged DNA, such as with inherited cancers. More often, though, an individual's DNA becomes damaged by exposure to something in the environment, such as smoking or radiation from the sun.

The immune system, which is made up of special cells, proteins, tissues, and organs, defends individuals against invasion by pathogens (disease-causing agents), such as cancer cells, bacteria, and viruses. The differences between cancer cells and normal cells may not be easily detected, and the immune system may not always recognize cancer cells as pathogens. Most healthy individuals have immune systems that can keep up with the pathogens, but sometimes problems with the immune system can lead to illness and infection.

Cancer cells sometimes travel through the blood or lymphatic system to other parts of the body. The cancerous cells begin to grow and replace normal tissue in a process called metastasis. Regardless of where cancer may spread, it is always named for the place it began. For instance, colon cancer that spreads to the liver is still called colon cancer, not liver cancer.

According to the American Cancer Society (ACS), cancer is the leading cause of death among Americans under the age of 85. Half of all men and one-third of all women in the United States will develop cancer during their lifetimes. Although cancer occurs in Americans of all racial and ethnic groups, the rate of cancer occurrence varies from group to group. Two-thirds of individuals diagnosed with cancer are aged over 65 years. In 2005, 7.6 million people died of cancer, out of 58 million deaths worldwide. Based on projections, cancer deaths will continue to rise, and an estimated nine million people will die from cancer in 2015, and 11.4 million may die in 2030.

Early diagnosis makes it more likely that cancer can be treated successfully. It is important that individuals are aware of possible symptoms and that individuals see a doctor for regular checkups.

Age: The chances of developing cancer increases with age. In the United States, more than 60% of cancers occur in people older than 65. The risk of developing cancer doubles every five years after the age of 25. The increased cancer rate is probably due to a combination of increased and prolonged exposure to carcinogens and a weakening of the body's immune system.

Environmental Factors: The environment we live in can cause an individual to have an increased risk of developing various types of cancers. Studies have reported that individuals exposed to high amounts of benzene, which is commonly found in gasoline, cigarettes, and pollution, are at an increased risk for developing cancer.

Certain chemicals found in pesticide products, such as lawn and garden chemicals, may increase the risk of developing cancers such as lymphoma. Long-term use of hair products, including permanent hair dyes (especially dark colors) and hair-straightening chemicals, doubles an individual's risk of developing lymphoma, particularly among women and persons who used hair dyes before 1980. These dyes contained more carcinogenic (cancer-causing) substances than the dyes used today, due to changes in regulations by the U.S. Food and Drug Administration (FDA).

Studies have reported that exposure to chemicals and pesticides can significantly increase the chances of developing breast cancer. Being overweight increases the chances of developing many types of cancer, such as ovarian cancer. A high-fat diet may increase the chances of developing colon cancer. Exercising at least 30 minutes daily, five days per week may reduce the risk of developing cancer.

Diet and lifestyle: Exposure to charred red meat has been reported to increase the risk of developing colon cancer. Diets low in fruits and vegetables have been linked to an increased risk of cancers, including cervical cancer.

Heredity: Heredity, or genetics, plays a large role in cancer development. A family history of cancer, such as breast, ovarian, or colon cancer, increases the risk of the individual developing that type of cancer. When cancer is genetic, a mutated gene has been passed down. However, this does not always mean that the genetically predisposed individual will always develop cancer. Genetic tests are available for many cancers that are hereditary.

Personal history of cancer: If an individual has had any type of cancer, there is an increased risk of developing that cancer again. Cancer can be in remission (a period of time when the cancer is responding to treatment or is under control) and then return at a later time.

Pre-existing medical conditions: Pre-existing medical conditions can increase an individual's risk of developing various forms of cancer. Inflammatory bowel diseases such as ulcerative colitis and Crohn's disease increase the risk of colon cancer. Individuals with diabetes have as high as a 40% increased risk of developing colorectal cancer. A recent report found that men with testicular cancer had a higher rate of colorectal cancer. Men who receive radiation therapy for prostate cancer have also been reported to have a higher risk of rectal cancer.

Ethnicity: Some research suggests that ethnicity may play a role in the development of various types of cancer. However, it is important to note that the following statistics may be correlations that do no necessarily have to do with ethnicity or genetics, but rather influenced by social factors associated with people of certain ethnicities (such as diet, access to healthcare, and quality of healthcare). Caucasian families have about a 17% risk for developing lung cancer, while African-Americans have a much higher risk, around 25%. Jews of Eastern European descent (called Ashkenazi Jews) have a higher incidence of developing colon cancer. Caucasian women are more likely to develop breast cancer than African-American or Latino women. In the United States, African-American men have a 60% higher incidence rate of developing prostate cancer compared to Caucasian men.

Sun exposure: Individuals who spend a considerable amount of time in the sun can develop skin cancer, especially if the skin is not protected by sunscreen or clothing. Ultraviolet (UV) rays from the sun can damage the DNA of skin cells and cause their mutation into cancerous cells. Tanning is the skin's injury response to excessive UV radiation, and it increases the risk of skin cancer. Every time an individual gets sunburned or is exposed to too much UV radiation, there is an increased risk of damaging skin cells and developing skin cancer. One or more severe, blistering sunburns can increase the risk of skin cancer as an adult.

Tobacco: Smoking cessation decreases the risk for developing various types of cancer. According to the National Cancer Institute (NCI), smoking causes 30% of all cancer deaths in the United States and is responsible for 87% of cases of lung cancer. Smoking affects the lungs and kidneys and has been reported to cause pancreatic, cervical, and stomach cancers and acute myeloid leukemia. Cancers of the mouth, larynx, bladder, cervix, and esophagus are also related to tobacco. A study found that exposure to secondhand smoke increases the risk of breast cancer in premenopausal women and lung cancer in the general population.

Weak immune system: Individuals with a weakened immune system, including those living with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), or leukemia, and those taking immunosuppressant drugs after an organ transplant are at a greater risk for developing certain types of cancer, including skin cancer.

Viral infections: Practicing unsafe sex can increase the risk of developing human papillomavirus (HPV). HPV is a group of over 100 viruses that increase the risk of developing cervical, anal, vulvar, and vaginal cancer. Hepatitis B virus can cause liver cancer. Some human retroviruses cause lymphomas and other cancers of the blood system. Some viruses produce cancer in certain regions but not in others. For instance, the Epstein-Barr virus causes Burkitt's lymphoma (a type of cancer) in Africa and cancers of the nose and pharynx in China.

There are over 100 different types of cancer. They are all unique, with their own symptoms and characteristics. Each cancer affects the body in a different way. Although cancers differ greatly, there are a few cancer symptoms that are commonly experienced by most cancer patients. Symptoms can be general (also called nonspecific), such as pain or unexplained weight loss. Other symptoms are more specific, such as unusual bleeding in the vagina, which is common in vaginal cancer, or difficulty swallowing, which is common in esophageal cancer.

Nonspecific symptoms:

Depression: Cancer often results in depression. Depression can be related to the symptoms of the illness, a fear of dying, or a loss of independence. Additionally, some cancers may produce tumors that directly cause depression by affecting normal brain function.

Fatigue: Fatigue, or extreme tiredness, is one of the most commonly experienced symptoms of cancer. Fatigue may occur early in cancers that cause a chronic loss of blood, including colon or stomach cancers and leukemia. Fatigue is more common when the cancer is advanced, but it also occurs in early stages.

Fever: Most cancer patients experience a fever at some point, particularly if the cancer or its treatment (including chemotherapy and radiation) affects the immune system and reduces resistance to infection. Less often, fever may be an early sign of cancer, such as with leukemia or lymphoma.

Neurological and muscular symptoms: Cancer can grow directly onto or compress nerves, causing any of several neurological and muscular symptoms, including a change in sensation (such as tingling sensations) or muscle weakness. When a cancer grows in the brain, symptoms may be hard to pinpoint but can include confusion, dizziness, headaches, nausea, changes in vision, and seizures.

Pain: Pain is normally present when cancer progresses. However, pain can be present early on in some cancers, such as bone or testicular cancers.

Respiratory symptoms: Cancer can compress or block physical structures, such as the airways in the lungs or trachea, causing shortness of breath, cough, or pneumonia. Shortness of breath can also occur when the cancer causes a fluid to enter the lungs, bleeding into the lungs, or anemia (a lack of red blood cells, which carry oxygen to tissues).

Unintentional weight loss: Most individuals with cancer will lose weight at some time with their disease. Losing 10 or more pounds without dieting or intending to lose weight can be one of the first symptoms experienced with cancer, particularly cancers of the pancreas, stomach, esophagus, or lung.

Specific symptoms:

Bladder cancer: Individuals with bladder cancer may have blood in the urine, pain or burning upon urination, frequent urination, or cloudy urine.

Bone cancer: Individuals with bone cancer may often experience pain in the bone, swelling around the affected site, fractures in bones, weakness, fatigue, weight loss, repeated infections, nausea, vomiting, constipation, problems with urination, weakness or numbness in the legs, or bumps and bruises that do not heal easily.

Brain cancer: Individuals with brain cancer often experience dizziness; drowsiness; abnormal eye movements or changes in vision; weakness; loss of feeling in the arms or legs or difficulties in walking; fits or convulsions; changes in personality, memory, or speech; headaches that tend to be worse in the morning and ease during the day; or headaches that may be accompanied by nausea or vomiting.

Breast cancer: Although most lumps are not cancerous, individuals with breast cancer may have a lump or thickening of the breast, which is the most common sign of breast cancer for both men and women. Often, the lump is painless. Other symptoms of breast cancer may include a spontaneous clear or bloody discharge from the nipple often associated with a breast lump, retraction or indentation of the nipple, a change in the size or contours of the breast, flattening or indentation of the skin over the breast, and redness or pitting of the skin over the breast (similar to the skin of an orange).

Kidney cancer: Individuals with kidney cancer often experience blood in the urine, a dull ache or pain in the back or side, or a lump in the kidney area, sometimes accompanied by high blood pressure or an abnormality in the red blood cell count.

Lung cancer: Individuals with lung cancer often experience a wheezing, persistent cough for months, blood-streaked sputum, a persistent ache in the chest, congestion in the lungs, or enlarged lymph nodes in the neck.

Melanoma: Individuals with melanoma often experience a change in a mole or other bump on the skin, including bleeding or change in size, shape, color, or texture.

Non-Hodgkin's lymphoma: Individuals with non-Hodgkin's lymphoma often experience painless swelling in the lymph nodes in the neck, underarm, or groin; persistent fever; a feeling of fatigue; unexplained weight loss; itchy skin and rashes; small lumps in skin; bone pain; swelling in the abdomen; or liver or spleen enlargement.

Oral cancer: Individuals with oral cancer often experience a lump in the mouth; ulceration of the lip, tongue, or inside of the mouth that does not heal within a couple of weeks; dentures that no longer fit well; oral pain or bleeding; foul breath; loose teeth; or changes in speech.

Pancreatic cancer: Individuals with pancreatic cancer often experience upper abdominal pain and unexplained weight loss; pain near the center of the back; an inability to eat fatty foods without experiencing gas, bloating, nausea, or vomiting; yellowing of the skin; abdominal masses; or enlargement of liver and spleen.

Prostate cancer: Individuals with prostate cancer often experience urination difficulties due to blockage of the urethra; urinary retention, creating frequent feelings of urgency to urinate, especially at night; incomplete bladder emptying; burning or painful urination; bloody urine; tenderness over the bladder; or dull ache in the pelvis or back.

Stomach cancer: Individuals with stomach cancer often experience indigestion or heartburn, discomfort or pain in the abdomen, nausea and vomiting, diarrhea or constipation, bloating after meals, loss of appetite, weakness and fatigue, or bleeding (such as vomiting blood or blood in the stool).

Cancer remission: Remission is a period of time when the cancer is responding to treatment or is under control. Cancer cells stop growing out of control. In a complete remission, all the signs and symptoms of the disease disappear. It is also possible for a patient to have a partial remission in which the cancer shrinks but does not completely disappear. Remissions can last anywhere from several weeks to many years. Complete remissions may continue for years and be considered cures. If the disease returns, another remission often can occur with further treatment. A cancer that has recurred may respond to a different type of therapy, including a different drug combination. Recurrence of cancer may not respond to the same medications and treatments as the cancer did before remission.

Spontaneous remission of cancer refers to exceptional and unexplained partial or complete disappearance of cancer without medical intervention.

Cancer is diagnosed based on an individual's symptoms, the results of a physical examination, and sometimes the results of screening tests. Confirmation that cancer is present requires diagnostic tests.

Screening:

Screening tests serve to detect the possibility that a cancer is present before symptoms occur. Screening tests are an important prophylactic measure for detecting cancer early, and healthcare professionals recommend cancer screening. Screening tests usually are not perfect; results are confirmed or disproved with further examinations and tests. Diagnostic tests are performed once a doctor suspects that an individual has cancer.

Although screening tests can help save lives, they can be costly and can produce false-positive results, or results that suggest that a cancer is present when it actually is not. False-positive results can create undue psychological stress and can lead to other tests that are expensive and risky. Screening tests can also produce false-negative results, or results that show no presence of a cancer that is actually present. However, cancer screening is important for individuals with risk factors for cancer, including age, race, heredity, and lifestyle (such as smoking, lack of exercise, or being overweight). The American Cancer Society has cancer screening guidelines that are widely used by healthcare providers.

Recommendations for cancer screening are influenced by many factors, including age, race, previous medical history, and lifestyle. These screening recommendations are for individuals with no symptoms and with an average risk of cancer. For individuals with a higher risk, such as those with a strong family history of certain cancers or those who have had a previous cancer, screening may be recommended more frequently or to start at a younger age. Screening tests other than those listed here may also be recommended. An individual's physician will help decide when to begin screening and which tests should be used.

Breast cancer: Breast self-examination is recommended monthly after age 20. A physical examination by a healthcare provider is recommended every three years between the ages of 20 and 39, then yearly. A mammography is recommended yearly starting at age 40.

Cervical cancer: A Papanicolaou (Pap) test is recommended yearly for individuals younger than 30 years of age. Some women 65-70 years of age or older who have had three or more normal Pap tests in a row may choose to stop having cervical cancer screening. For women over 30, some doctors recommend testing every three years with a conventional Pap test plus the human papillomavirus DNA test.

Lung cancer: Chest X-ray, sputum cytology (examining the sputum for changes in cells), and computed tomography (CT) are not recommended on a routine basis. If an individual presents with symptoms of lung cancer, such as persistent hoarseness or cough, these tests may be performed.

Prostate cancer: A rectal examination is recommended yearly for men after age 50. A prostate-specific antigen (PSA) blood test is also recommended yearly after age 50.

Rectal and colon cancer: A stool examination for occult (hidden) blood should be performed yearly after age 50. A sigmoidoscopic examination every five years beginning at age 50, or a colonoscopic examination every 10 years beginning at age 50, should be performed. In a sigmoidoscopic exam, the doctor uses a flexible, slender, and lighted tube to examine the rectum and sigmoid colon (approximately the last two feet of the colon). The test is fast but can sometimes be uncomfortable. If a polyp or colon cancer is found during this exam, the doctor will recommend a colonoscopy to look at the entire colon and remove any polyps for further examination under a microscope.

Skin cancer: A physical examination should be part of a routine checkup. More frequent examinations may be needed for individuals at high risk for developing skin cancer, such as those with fair skin or frequent sunburns. Whole-body photography is not routinely needed, although it may be helpful for those with multiple moles or in whom examination of the skin is difficult.

Diagnosis:

Generally, when a doctor first suspects cancer, some type of imaging study, such as X-ray, ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI), is performed. Although these tests can show the presence, location, and size of an abnormal mass, they usually can not confirm that cancer is the cause. Cancer is confirmed by finding cancer cells on microscopic examination of samples from the suspected area. Usually, the sample must be a piece of tissue, although sometimes examination of the blood is enough (such as in leukemia). Obtaining a tissue sample is termed a biopsy. Biopsies can be performed by cutting out a small piece of tissue with a scalpel (surgical knife), but very commonly, the sample is obtained using a hollow needle. Such tests are commonly done without the need for an overnight hospital stay (called outpatient procedures). Doctors often use ultrasonography or a computerized tomography (CT) scan to guide the needle to the right location. Because biopsies can be painful, the individual is usually given a local anesthetic (such as lidocaine or Xylocaine®) to numb the area.

In cases with findings on examination or imaging tests that suggest cancer, measuring blood levels of tumor markers may provide additional evidence for or against the diagnosis of cancer. Tumor markers are substances produced by tumor cells or by other cells of the body in response to cancer or certain benign (noncancerous) conditions. Tumor markers can be found in the blood, the urine, the tumor tissue, or other tissues. Different tumor markers are found in different types of cancer, and levels of the same tumor marker can be altered in more than one type of cancer. In addition, tumor marker levels are not altered in all people with cancer, especially if the cancer is in the early stages. Some tumor marker levels can also be altered in patients with noncancerous conditions. In individuals who have been diagnosed with certain types of cancer, tumor markers may be useful to monitor the effectiveness of treatment and to detect possible recurrence of the cancer. For some cancers, the level of a tumor marker drops following treatment and increases if the cancer recurs. Common cancer tumor markers include alpha-fetoprotein (AFP), which may be raised in individuals with colon cancer; beta2-microglobulin, which may occur in individuals with multiple myeloma; carcinoembryonic antigen (CEA), which may be raised in individuals with colon cancer; prostate-specific antigen (PSA), which may be increased in individuals with prostate cancer; and carbohydrate antigen 27.29 (CA27.29), which may be increased in individuals with breast cancer. Using tumor markers for cancer diagnosis is beneficial, because of the ease of obtaining and measuring their presence; also, there is less discomfort for patients.

Staging:

After cancer is diagnosed, it is staged. Staging is the process of finding out how far the cancer has spread. Staging the cancer is a vital step in determining treatment choices, and it will also give the healthcare team a clearer idea of the outlook for recovery. There can be several different processes for staging each individual cancer, such as with brain cancer, lymphoma, or melanoma.

The TNM system is the most widely used staging. The "T" describes the size of the tumor, and whether the cancer has invaded nearby tissues and organs. The "N" describes how far the cancer has spread to nearby lymph nodes. The "M" shows whether the cancer has metastasized (spread) to other organs of the body. Once the TNM descriptions have been established, they can be grouped together into a simpler set of stages, stages 0 through stage IV (0-4). In general, the lower the number, the less the cancer has spread. A higher number, such as stage IV (4), means a more serious, widespread cancer. A T1N2M0 cancer would be a cancer with a T1 tumor, N2 involvement of the lymph nodes, and no metastases (no spreading through the body).

Metastasis: Metastasis (spreading) to other organs, such as the liver, pancreas, lungs, and lymph nodes, may occur, causing an increase chance of death. Metastasis allows cancerous cells to spread to other tissues in the body and more than one body system, causing more damage.

Cardiac tamponade: Cardiac tamponade occurs when fluid accumulates in the pericardium, or baglike structure surrounding the heart. This fluid puts pressure on the heart and interferes with its ability to pump blood. Fluid can accumulate when a cancer invades and irritates the pericardium.

Superior vena cava syndrome:
Superior vena cava syndrome occurs when cancer partially or completely blocks the superior vena cava, which is a vein that drains blood from the upper part of the body into the heart. Blockage of the superior vena cava causes the veins in the upper part of the chest and neck to swell, resulting in swelling of the face, neck, and upper part of the chest.

Spinal cord compression:
Spinal cord compression occurs when cancer compresses the spinal cord or the spinal cord nerves, resulting in pain and loss of function (such as urinary or fecal incontinence). The longer the compression of the spinal cord or spinal cord nerves persists, the less likely normal nerve function will return when the compression is relieved.

Brain dysfunction: Brain dysfunction occurs when the brain functions abnormally as a result of a cancer growing within the brain, either as a primary brain cancer or more commonly as a metastasis from a cancer elsewhere in the body. Tumors may develop and put pressure on sensitive nerves and blood vessels, causing symptoms such as confusion, drowsiness, agitation, headaches, abnormal vision, abnormal sensations, weakness, nausea, vomiting, and seizures.

Bleeding: At first, a cancer may bleed slightly because its cells are not well attached to each other and its blood vessels are fragile. Later, as the cancer enlarges and invades surrounding tissues, it may grow into a nearby blood vessel, causing bleeding. The bleeding may be slight and undetectable or detectable only with testing. Such is often the case in early-stage colon cancer. Or, particularly with advanced cancer, the bleeding may be more significant, even massive and life threatening. The site of the cancer determines the site of the bleeding. Cancer anywhere along the gastrointestinal tract can cause bleeding in the stool. Cancer anywhere along the urinary tract can cause bleeding in the urine. Other cancers can bleed into internal areas of the body. Bleeding into the lungs can cause the individual to cough up blood.

The number of treatment choices an individual has will depend on the type of cancer, the stage of the cancer, and other individual factors such as age, health status, and personal preferences. Individuals should discuss all treatment options with their cancer team. It is important to ask questions and to understand all the cancer treatment options available.

The four major types of treatment for cancer are surgery, radiation, chemotherapy, and biologic therapies. The specific cancer treatment will be based on the individual's needs. Certain types of cancer respond very differently to different types of treatment, so determining the type of cancer is a vital step toward knowing which treatments will be most effective. The cancer's stage (how widespread it is) will also determine the best course of treatment, since early-stage cancers respond to different therapies than later-stage ones. The individual's overall health, lifestyle, and personal preferences will also play a part in deciding which treatment options will be best.

It is important for individuals to understand the goals of treatment. The treatment can either be palliative, which helps control symptoms (such as pain), or curative, which may help cure the cancer and decrease the chances of it returning. The goal of cancer treatments and therapies is to increase the quality of life for the individual suffering from this condition.

Chemotherapy:

While surgery and radiation therapy are used to treat localized cancers, chemotherapy is used to treat cancer cells that have metastasized (spread) to other parts of the body. Chemotherapy is also used in combination with surgery and/or radiation or to shrink tumors, which helps surgery be easier on the patient and safer. Depending on the type of cancer and its stage of development, chemotherapy can be used to cure cancer, to keep the cancer from spreading, to slow the cancer's growth, to kill cancer cells that may have spread to other parts of the body, or to relieve symptoms caused by cancer. Not all individuals will respond the same way to chemotherapy treatments, and some individuals will have more success than others.

Prior to chemotherapy: The individual undergoing chemotherapy may be asked to take some medications prior to the procedure (called premedications), including steroids, such as prednisone (Deltasone®) or hydrocortisone (Solu Medrol®); antihistamines (allergy medications), such as diphenhydramine (Benadryl®); antinausea medications, such as ondansetron (Zofran®); sedatives, such as alprazolam (Xanax®); or antibiotics, such as levofloxacin (Levaquin®).

During chemotherapy: Individuals will be given the chemotherapy medications by whichever route the doctor thinks best. Chemotherapy drugs can be given by mouth; injected through a syringe into a vein, artery, or muscle; given intravenously though a drip device; placed into a catheter (tube) that goes into the bladder, chest cavity, brain, spinal cord, liver, or abdomen; or applied to the skin. The decision on which route to use depends on several factors, mainly the type of tumor and the drug being used.

At the same time, individuals may be given other medications to fight the side effects of chemotherapy, including steroids, allergy medications (antihistamines), antinausea medications, sedatives, and antibiotics.

Chemotherapy drugs: Almost all chemotherapy agents available kill cancer cells by affecting DNA synthesis or function, a process that occurs through the cell cycle. Each drug varies in the way this occurs within the cell cycle.

The major categories of chemotherapy agents are alkylating agents, antimetabolites, plant alkaloids, antitumor antibiotics, and steroid hormones. Each drug is categorized according to its effect on the cell cycle and cell chemistry.

Alkylating agents kill cells by directly attacking DNA. Alkylating agents may be used in the treatment of chronic leukemias, Hodgkin's disease, lymphomas, and certain carcinomas of the lungs, breasts, prostate, and ovaries. Cyclophosphamide (Cytoxan®) is an example of a commonly used alkylating agent.

Nitrosoureas act similarly to alkylating agents and also inhibit changes necessary for DNA repair. These agents cross the blood-brain barrier and are therefore used to treat brain tumors, lymphomas, multiple myeloma, and malignant melanoma. Carmustine (BCNU or BiCNU®) and lomustine (CCNU, or CeeNU®) are the major drugs in this category.

Antimetabolites are drugs that block cell growth by interfering with certain activities, usually DNA synthesis. Once ingested into the cell, they halt normal development and DNA reproduction. Antimetabolites may be used in the treatment of acute and chronic leukemias, choriocarcinoma, and some tumors of the gastrointestinal tract, breast, and ovaries. Examples of commonly used antimetabolites are 6-mercaptopurine (Purinethol®) and 5-fluorouracil (5FU, or Leucovorin®).

Antitumor antibiotics are a diverse group of compounds. In general, they act by binding with DNA and preventing RNA synthesis. These agents are widely used in the treatment of a variety of cancers. The most commonly used drugs in this group are doxorubicin (Adriamycin®), mitomycin-C (Mutamycin®), and bleomycin (Blenoxane®).

Mitotic inhibitors are compounds derived from natural substances that inhibit mitosis (a stage of division) or cellular reproduction. Examples include paclitaxel (Taxol®), docetaxel (Taxotere®), ixabepilone (Ixempra®), and estramustine (Emcyt®). Ixabepilone (Ixempra®) was approved by the U.S. Food and Drug Administration in October 2007 for use in patients with metastatic or locally advanced breast cancer and who have not responded to certain other cancer drugs.

Vinca alkaloids are also examples of mitotic inhibitors, which are derived from the periwinkle plant (Vinca sp.). These drugs act specifically by blocking cell division during mitosis. They are commonly used in the treatment of acute lymphoblastic leukemia, Hodgkin's and non-Hodgkin's lymphomas, neuroblastomas, Wilms' tumor, and cancers of the lungs, breasts, and testes. Vincristine (Oncovin®) and vinblastine (Velbe®) are commonly used agents in this group.

Steroid hormones are useful in treating some types of tumors. This class includes adrenocorticosteroids, estrogens, antiestrogens, progesterones, and androgens. Although their specific mechanism of action is not clear, steroid hormones modify the growth of certain hormone-dependent cancers. Tamoxifen (Nolvadex®) is an example, and it is used for estrogen-dependent breast cancer.

Platinum-based chemotherapy drugs contain the metal platinum. They are used to treat various types of cancers, including sarcomas, some carcinomas (e.g., small cell lung cancer and ovarian cancer), lymphomas, and germ cell tumors. Examples include cisplatin (Platinol®), carboplatin (Paraplatin®), and oxaliplatin (Eloxatin®).

Often, a combination of chemotherapy is used instead of a single drug. Chemotherapy is given in cycles, each followed by a recovery period. The total course of chemotherapy is often about six months, usually ranging from three to nine months. After a cancer is removed by surgery, chemotherapy can significantly reduce the risk of cancer returning. The chances of cancer returning and the potential benefit of chemotherapy depend on the type of cancer and other individual factors.

After chemotherapy: After chemotherapy, individuals may be given any of the following medications: antinausea drugs, injections of immune system-boosting drugs (to increase white blood cells that fight potential infections) several days after the chemotherapy has been given, or other drugs, including steroids, antihistamines, sedatives, or antibiotics.

Side effects of chemotherapy: A major concern with chemotherapy is the possibility of long-term side effects and complications, such as heart damage, lung damage, liver damage, and secondary cancers (including leukemia). Although these severe effects occur in only a small number of people, great effort is being put into finding equally effective regimens with less toxicity. Drug regimens have been developed that substantially diminish the likelihood of long-range, life-threatening complications, including acute leukemia in people who have received multiple courses of chemotherapy and radiation therapy.

The side effects of chemotherapy depend on the type of drugs, the amounts taken, and the length of treatment. The most common are nausea and vomiting, temporary hair loss, increased chance of infections, and fatigue (extreme tiredness). Many of these side effects can be uncomfortable or emotionally upsetting. However, most side effects can be controlled with medicines, supportive care measures, or by changing the treatment schedule.

Fatigue is one of the most common side effects of radiation and chemotherapy. Like most other side effects, fatigue will usually disappear once the treatment is complete. Individuals need to get plenty of rest, eat a well-balanced diet (less meats, dairy, and fats, and more vegetables), and drink plenty of water. Hair loss may occur with some types of chemotherapy. Some individuals experience hair loss during chemotherapy treatments (and sometimes with radiation treatment to the head), while others do not, even with the same drugs. If hair loss does occur, it usually begins within two weeks of the start of therapy and gets worse 1-2 months after the start of therapy. Hair growth often begins even before therapy is completed. Most people are able to find suitable ways of managing the hair loss until it grows back, with specially designed hats, scarves, and wigs.

Nail-related problems may occur as a result of drug therapy, specifically, cancer treatments including both chemotherapy and radiation. These nail changes do not happen with every type of cancer treatment, but nail changes are a fairly common result of chemotherapy and radiation. Some of these nail problems include hyperpigmentation (color changes), Beau's lines, Mee's lines, half-and-half nails, or onycholysis (nail detachment). Mee's lines are single or multiple white lines that extend across the nail. Medications that have produced Mee's lines include doxorubicin, cyclophosphamide, and vincristine. With half-and-half nails, nails appear reddish brown at the base and are abnormally white toward the tip of the nail. In some cases nails may completely fall off (called onychomadesis). These nail changes can occur with both fingernails and toenails and may involve one or multiple nails. Many of these changes occur with multiple drugs and cancer treatments. However, some specific agents may cause nails to change certain colors. Patients may have nails change to blue in color after administration of bleomycin or 5-fluorouracil. Bleomycin, doxorubicin (Adriamycin®), doxorubicin, mitoxantrone, and idarubicin have all been known to cause nails to become brown in color. These changes often resolve once drug treatment is complete and the damaged nail grows out.

Medications for side effects of chemotherapy: Some individuals who experience certain side effects of chemotherapy may be prescribed medications to counteract these effects. Several drugs are now available for use alone or in combination to help reduce a few of the most common side effects, such as nausea, vomiting, and fatigue.

Anzemet® (dolasetron mesylate): Anzemet® helps prevent and relieve nausea and vomiting from surgery or chemotherapy. Researchers believe that nausea and vomiting during chemotherapy is associated with the release of serotonin from special cells in the small intestine. Anzemet® blocks these nerve endings in the intestine and prevents signals to the central nervous system. Anzemet® is available in tablet form and by injection.

Compazine® (prochlorperazine): Prochlorperazine helps control nausea and vomiting after surgery or chemotherapy. Prochlorperazine is available in capsule, tablet, and liquid form, and by suppository or injection. Prochlorperazine can cause drowsiness and may interact with other medications or alcohol.

Kytril® (granisetron hydrochloride): Kytril® is an antinausea medication that is approved by the U.S. Food and Drug Administration (FDA) for patients undergoing chemotherapy. Kytril® is typically given 60 minutes before chemotherapy. In some cases, a second dose is given about 12 hours after the first dose. Kytril® is available in tablet form and by injection.

Phenergan® (promethazine): Promethazine has sedative, antihistamine, and mild antinausea properties. It may be used to help prevent or treat nausea due to chemotherapy. Promethazine may be available in tablet form or as an oral syrup, suppository, or injection.

Procrit® (epoetin alfa): Procrit® helps the body produce more red blood cells, which help relieve fatigue due to chemotherapy. Since chemotherapy affects both normal and cancerous cells, it can decrease the number of red blood cells, which leads to anemia (lack of red blood cells to carry oxygen) and a feeling of extreme tiredness.

Neupogen® (filgrastim):
Neupogen® is the trade name for granulocyte colony-stimulating factor (G-CSF, or filgrastim). Neupogen® is a protein-based drug that stimulates the production of white blood cells. White blood cells are important for protecting the body from infection. Neupogen® is used to increase white blood cells and to decrease the risk of infection in conditions such as cancer. Neupogen® can be used subcutaneously (injected under the skin) or intravenously (injected into a vein). Side effects may include nausea, bone pain, and swelling or redness at the injection site. Healthcare providers recommend contacting a doctor immediately if the individual develops a fever, chills, sore throat, congestion, diarrhea, or redness, pain, or swelling around a wound or sore while using Neupogen®.

Zofran® (ondansetron): Zofran® helps to relieve nausea and vomiting associated with chemotherapy. Zofran® is available in pill form, as a liquid solution, and by injection. The first dose of Zofran® (tablet form) is usually administered 30 minutes before chemotherapy and then at regular intervals for 1-2 days after chemotherapy.

Myelodysplastic syndrome: Myelodysplastic syndromes are diseases of the blood and bone marrow, often caused by chemotherapy. Blood cells, such as red blood cells that carry oxygen to tissues and white blood cells that help produce cells for immunity, are damaged by chemotherapy medicines. Symptoms of myelodysplastic syndrome include fatigue and chronic tiredness, shortness of breath, chilled sensation, chest pain (occasionally), an increased susceptibility to infection, and an increased susceptibility to bleeding. Patients who experience low blood cells counts during chemotherapy may also be given medications to help raise blood cell or platelet counts. For example, patients who suffer from neutropenia, a decrease in the number of neutrophils (a type of white blood cell), may be given certain growth factors, such as the granulocyte-macrophage colony-stimulating factor (GM-CSF, sargramostim, or Leukine®) or Neupogen®.

Cryotherapy:
Some patients receiving certain cancer mediations such as docetaxel may have reduced nail toxicity by receiving cryotherapy while medication is administered. Cryotherapy works by keeping the nails colder then the rest of the body, ultimately reducing the likelihood of the chemotherapeutic drug reaching the nails as easily. Patients wear frozen gloves or socks prior to, during, and for a short period of time after the administration of chemotherapy. Secondary sources suggest that placing the hands or feet in ice water during chemotherapy may also help delay or prevent nail changes.

Radiation therapy:

Radiation therapy uses high-energy rays to kill cancer cells. It is considered a local therapy, meaning that it should be used to target areas of the body invaded by tumor masses. A radiation oncologist plans and supervises therapy. The area to be treated is carefully mapped out, and the treatment machine is adjusted so that only the lymphoma cells are exposed to a full dose of radiotherapy. Because of the need to target the radiation at exactly the right area of the body, a mold is sometimes made that will help to hold that part of the body still and in position during the treatment sessions.

Normal cells surrounding the lymphoma are spared the full dose, and these cells are usually able to repair themselves more easily than lymphoma cells. Therefore, radiotherapy can often control or destroy lymphoma cells, while causing only temporary damage to normal cells.

Radiotherapy is usually given on an outpatient basis, with the patient visiting the hospital up to five times per week. Before each treatment, the patient is carefully positioned, usually lying on a treatment table. Parts of the body that are not being treated may be covered. It is important to remain completely still during the treatment. Each treatment usually lasts only a few minutes and causes no discomfort. Although the patient is left alone during the actual treatment, the radiotherapy technician watches from an observation room, and it is possible to talk to the individual through a microphone. A course of radiotherapy typically lasts between two and six weeks, depending on the patient's individual circumstances. The length of radiation treatment varies depending on the stage of the disease. Radiation therapy may be used alone, but it is commonly used in conjunction with chemotherapy.

Depending on how and where the radiation is administered, it may cause certain side effects such as fatigue (extreme tiredness), loss of appetite, nausea, diarrhea, skin, and nail problems. Radiation of lymph node areas may result in suppression of the immune system to varying degrees. Irradiation of the underlying bone and the marrow within the bone may result in suppression of the blood counts.

Surgery:

Surgery is the treatment of choice for many types of cancer, such as colon or breast cancer. Treatment depends on the stage of the disease and the overall health of the patient. Chemotherapy and radiation therapy may be used as adjuvant treatment (in addition to surgery).

Cryosurgery: During cryosurgery, a doctor uses very cold material, such as liquid nitrogen spray, or a cold robe to freeze and destroy cancer cells or cells that may become cancerous (such as irregular cells in the cervix that could become cervical cancer).

Electrosurgery: Electrosurgery is the application of high-frequency electrical currents by a doctor. These currents can kill cancer cells, such as in the mouth or on the skin.

Laser surgery: Laser surgery is used to treat many types of cancer. Laser therapy uses high-intensity light to treat cancer and other illnesses. Lasers can be used to shrink or destroy tumors. Lasers are most commonly used to treat superficial cancers (cancers on the surface of the body or the lining of internal organs), such as basal cell skin cancer, and the very early stages of some cancers, such as cervical, penile, vaginal, vulvar, and non-small cell lung cancer.

Mohs' surgery: Mohs' surgery is useful for removing cancer from sensitive areas such as near the eye. Mohs' surgery is also useful for assessing how deep a cancer is growing. Mohs' surgery is performed by carefully removing cancer layer by layer with a scalpel or knife. After removing a layer, the doctor will evaluate the cells under a microscope until all the abnormal cells have been removed and the surrounding tissue shows no evidence of cancer.

Laparoscopic surgery: In laparoscopic surgery (or minimally invasive surgery), a surgeon uses a laparoscope to see inside the body without making large incisions. A laparoscope is a telescopic rod lens system that is usually connected to a video camera. Several small incisions are made and a tiny camera and surgical tools are inserted into the body. The surgeon watches a monitor that projects what the camera sees inside the body. The smaller incisions mean faster recovery and a reduced risk of complications. Laparoscopic surgery is used in cancer diagnosis, staging, treatment, and symptom relief.

Robotic surgery: In robotic surgery, the surgeon sits away from the operating table and watches a screen that projects a three-dimensional image of the area being operated on. The surgeon uses hand controls that tell a robot how to maneuver surgical tools to perform the operation. Robotic surgery helps the surgeon operate on hard-to-reach areas. But robotic surgical systems are expensive and require specialized training, so robotic surgery is only available in specialized medical centers.

Clinical trials:

Human studies of promising new or experimental treatments are known as clinical trials. A clinical trial is only done when there is some reason to believe that the treatment being studied may be valuable to the patient. Treatments used in clinical trials are often found to have real benefits. Clinical trials are not commonly used as treatments for cancer, but they are an option. A doctor will help get information on various clinical trials available for certain types of cancer. There is no guarantee of success in clinical trials for the patients, and some individuals will actually not receive medication (receiving a placebo instead).

Types of clinical trials: There are three phases of clinical trials in which a treatment is studied before it can be approved by the U.S. Food and Drug Administration (FDA).

Phase I clinical trials: The purpose of a phase I study is to find the best way to give a new treatment and find out how much of it can be given safely. Doctors watch patients carefully for any harmful side effects. The treatment has been well tested in lab and animal studies, but the side effects in patients are not completely known. Doctors running the clinical trial start by giving very low doses of the drug to the first patients and increasing the dose for later groups of patients until side effects appear. Although doctors are hoping to help patients, the main purpose of a phase I study is to test the safety of the drug.

Phase II clinical trials: These studies are designed to see if the drug works. Patients are given the best dose of the drug (based on the results of the phase I study) and closely observed for an effect on the cancer. The doctors will also look for side effects.

Phase III clinical trials: Phase III studies are done to see if the new treatment is better than what is already available. They involve large numbers of patients. One group (the control group) receives the standard (most accepted) treatment. The other group receives the new treatment. All patients in phase III studies are closely watched. The study will be stopped if the side effects of the new treatment are too severe or if one group has much better results than the others.

If individuals enroll in a clinical trial, a team of experts will monitor their progress very carefully. The study is especially designed to pay close attention to individuals with cancer. However, there may be risks. Even with animal testing and laboratory studies, it is difficult to determine what side effects may occur in individuals undergoing clinical trials for cancer. It is important to discuss all potential risks and benefits carefully with a healthcare provider before making a decision to enroll in a clinical trial.

Other therapies:

Photodynamic therapy: Photodynamic therapy (PDT) is type of cancer treatment that uses lasers. In PDT, a drug called a photosensitizer or photosensitizing agent is injected into a patient and absorbed by cells all over the individual's body. After a couple of days, the agent is found mostly in cancer cells. Laser light is then used to activate the agent and destroy cancer cells. Because the photosensitizer makes the skin and eyes sensitive to light for approximately six weeks, individuals undergoing PDT are advised to avoid direct sunlight and bright indoor light during that time.

Perillyl alcohol:
Perillyl alcohol is a naturally occurring chemical with anticancer activity. Perillyl alcohol is found in lavender, cherries, and mint. The use of perillyl alcohol for cancer treatments is in phase I clinical trials.

Laetrile: Laetrile is a substance derived from a chemical called amygdalin, which is found in the seeds of apricots, plums, and bitter almonds. Laetrile has been publicized as an antineoplastic drug (preventing the development of a tumor or neoplasm), although there is no supporting evidence.

Pain control:

Pain may be acute or chronic. Acute pain is severe and lasts a relatively short time. It is usually a signal that body tissue is being injured in some way, and the pain generally disappears when the injury heals. Chronic or persistent pain may range from mild to severe, and it is present to some degree for long periods of time. Some individuals with chronic pain that is controlled by medicine can have breakthrough pain. This occurs when moderate-to-severe pain "breaks through" or is felt for a short time. Breakthrough pain may occur several times daily, even when the proper dose of medicine is given for chronic and persistent pain.

Pain may be caused by the cancer itself. Whether the individual has pain and the amount of pain they have may depend on the type of cancer, the stage (extent) of the disease, and the individual's pain threshold (tolerance for pain). Most of the pain comes when a tumor presses on bones, nerves, or body organs. Pain can also be caused by the treatment or procedures for diagnosing cancer.

Cancer pain is usually treated with analgesic (pain-relieving) drugs, both prescription and nonprescription, and with nondrug treatments such as relaxation techniques, biofeedback, imagery, and others. Healthcare providers recommend asking a doctor or pharmacist for advice before taking any medicine for pain.

Pain will generally be graded on a pain intensity scale. Using a pain scale is helpful in describing how much pain a patient is feeling. For the pain intensity scale, individuals answer questions and assign a number from zero to 10 according to their pain level. No pain gets a zero, while a 10 is the highest level of pain imaginable. Questions can include the severity of pain, how pain changes with medication, and how bad the pain is during the day and night. If one medicine or treatment does not work for the pain, there is almost always another one that can be tried. Changes may also be made in the frequency and dosages to help increase the pain relief.

Medications for pain: The type of medicine and the method by which the medicine is given depend on the type and cause of pain. Nonopiate (non-narcotic) pain medications are given for mild-to-moderate pain. These drugs can generally be purchased over-the-counter (OTC) and may include acetaminophen, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin®). It is best to check with a healthcare professional before taking any OTC medication. NSAIDs can slow blood clotting, especially if the individual is on chemotherapy due to drug interactions.

For moderate-to-severe pain, opiate (narcotic) medications may be given. These drugs include morphine (MS Contin®), fentanyl (Duragesic®), hydromorphone (Dilaudid®), and oxycodone (Percocet®, OxyContin®). Individuals must have a prescription for these medications, and the medications are generally time released, meaning their effects last more than a few hours. Nonopioids may be used along with opioids for moderate-to-severe pain. Opiate medications may cause side effects such as drowsiness and constipation. Their use may also cause addiction, both physical and psychological, in a short length of time. For breakthrough pain, immediate-release opiates may be given, such as oral morphine (Oramorph®) or oxycodone (Roxicodone®). A prescription is required for these medicines. A short-acting opioid, which relieves breakthrough pain quickly, needs to be used with a long-acting opioid for persistent pain. It is important to tell a doctor or pharmacist if taking any OTC medication, as some OTC medicines may contain acetaminophen (Tylenol®). Some prescription pain medications, such as an oxycodone/acetaminophen combination (Percocet®) or a hydrocodone/acetaminophen combination (Lortab®, Vicodin®), also contain acetaminophen, thereby increasing the potential for acetaminophen-induced liver toxicity.

Individuals who take opiates for pain sometimes find that over time they need to take larger doses. This may be due to an increase in the pain or the development of drug tolerance. Drug tolerance occurs when the body gets used to the medicine and does not relieve the pain as well as it once did. Many individuals do not develop a tolerance to opiates. If tolerance does develop, usually small increases in the dose or a change in the kind of medicine will help relieve the pain. Increasing the doses of opiates to relieve increasing pain or to overcome drug tolerance does not always lead to addiction. Alcohol should be avoided when taking medications for pain, due to a potential for interactions. Using alcohol in combination with pain medications can lead to overdose symptoms such as weakness, difficulty in breathing, confusion, anxiety, or more severe drowsiness or dizziness. It is recommended to use caution when driving automobiles or operating heavy machinery when taking opiate pain medications. Medications for pain may also cause nausea and vomiting in sensitive individuals.

For tingling and burning pain associated with some cancers, antidepressant medications (such as amitriptyline or Elavil®) or anticonvulsant medications (such as gabapentin or Neurontin®) may be used. Both these medications may cause drowsiness and sedation.

For pain caused by swelling, steroid medications, including prednisone (Deltasone®), may be used. Side effects of steroid medications include edema (swelling) and a decline in immune system function.

Pain medications may be given by several different routes, including orally (by mouth), topically (on the skin), and rectally (into the anus as a suppository). Pain medications may also be given by injection, including subcutaneous (SC) injection (injected just under the skin using a small needle), intravenous (IV, or injected directly into the vein through a needle), and intrathecal and epidural injections, which are placed directly into the fluid around the spinal cord (intrathecal) or into the space around the spinal cord (epidural). Patient-controlled analgesia (PCA) pumps may also be used. PCA pumps help control the amount of pain medicine an individual takes. When pain relief is needed, the individual can receive a preset dose of pain medicine by pressing a button on a computerized pump that is connected to a small tube placed in the body using a minor surgical technique.

Nondrug treatments for pain: Nondrug treatments are now widely used to help manage cancer pain. There are many techniques that are used alone or along with medicine. Some individuals find they can take a lower dose of medicine with such techniques. These methods include acupuncture, art therapy, focusing, healing touch, prayer, psychotherapy, transcutaneous electrical nerve stimulation (TENS), and yoga. See the "Integrative Therapies" section of this monograph for more information on these techniques.

Support groups:

Resources exist that provide cancer patients and their loved ones with an opportunity to learn ways of coping with the uncertainty that cancer brings and links to support groups that give them a chance to meet others who face similar issues. Support groups offer patients and loved ones emotional support, an opportunity to learn ways of coping with the uncertainty and changes in their lives, a chance to meet others who face similar issues, and a time to explore issues faced by all cancer survivors. Support groups for cancer patients can be located by asking a healthcare provider, such as a doctor or social worker, for more information.

Strontium: Strontium-89 chloride may relieve bone pain associated with prostate and breast cancer. Metastron® is drug approved by the U.S. Food and Drug Administration (FDA) for this use. In clinical research, up to 80% of people reported improvement and 10% reported complete pain relief.

Use cautiously in children; people with kidney dysfunction, Paget's disease, bleeding disorders, or other blood disorders (such as low platelet counts and low white blood cell counts); or those taking drugs that may increase the risk of bleeding. Use cautiously in people who are taking algin, androgens, bladderwrack, calcium supplements, estrogens, kelp, laminaria, nifedipine, vitamin D, or vitamin D analogs (such as calcitriol, cholecalciferol, or ergocalciferol). At least six months should be given when switching from a bisphosphonate to strontium. Avoid in people with severe kidney impairment, known allergy to strontium or any component of the formulation, or those who are pregnant or breastfeeding. Strontium found in toothpaste, however, appears to be safe during pregnancy and lactation. Avoid strontium ranelate in people using tetracycline or quinolone antibiotics or those with phenylketonuria (disorder in which a person is unable to properly break down the amino acid phenylalanine). Avoid intravenous strontium-89 (Metastron®) in people with incontinence or compromised bone marrow.

Vitamin A: Vitamin A is a fat-soluble vitamin that is derived from two sources: preformed retinoids and provitamin carotenoids. Retinoids, such as retinal and retinoic acid, are found in animal sources such as livers, kidneys, eggs, and dairy produce. Carotenoids, like beta-carotene (which has the highest vitamin A activity), are found in plants such as dark or yellow vegetables and carrots.

The prescription drug All-Trans-Retinoic Acid (ATRA, Vesanoid®) is a vitamin A derivative that is an established treatment for acute promyelocytic leukemia and improves median survival in this disease. Treatment should be under strict medical supervision. Vitamin A supplements should not be used simultaneously with ATRA due to a risk of increased toxicity.

Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously in those with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may have an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses. Use cautiously if breastfeeding, because the benefits or dangers to nursing infants are not clearly established.

Good scientific evidence:

Greater celandine: UkrainT, a semisynthetic drug derived from greater celandine (Chelidonium majus), has been studied in clinical trials of various types of cancer in general, with consistently positive outcomes. However, the quality of the research performed to date is inadequate, and higher-quality studies are needed.

Use cautiously in patients taking amphetamines, morphine, hexobarbital, MAOIs, or dopaminergic or serotonergic drugs, or in patients undergoing radiation therapy. Avoid in patients with liver disease or in pregnant and lactating women.

Guided imagery: Early research suggests that guided imagery may help reduce cancer pain. Further research is needed to confirm these results.

Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified healthcare provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously in those with physical symptoms that can be brought about by stress, anxiety, or emotional upset, because imagery may trigger these symptoms. Speak with a qualified healthcare provider if feeling unusually anxious while practicing guided imagery. With a history of trauma or abuse, speak with a qualified healthcare provider before practicing guided imagery.

Meditation: There is good evidence that various types of meditation may help improve quality of life in cancer patients. Studies have shown benefits for mood, sleep quality, and the stresses of treatment. The specific effects of meditation are not fully understood. Additional research is needed in this area.

Use cautiously in those with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professional(s) before starting a program of meditation, and they should explore how meditation may or may not fit in with their current treatment plan. Avoid in those at risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and it should not be used as the sole approach to illnesses.

Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental healthcare professional (psychiatrist, psychologist, clinical social worker, licensed counselor, or other trained practitioner). There is good evidence that psychotherapy may enhance quality of life in cancer patients by reducing emotional distress and aiding in coping with the stresses and challenges of cancer. Therapy may be supportive-expressive therapy, cognitive therapy, or group therapy. While some patients seek psychotherapy in hopes of extending survival, conclusive evidence of effects on medical prognosis is currently lacking. Psychotherapy may help people come to terms with the fact that they may die of cancer, which is the last stage of dealing with a terminal illness (the stages are denial, anger, bargaining, depression, and acceptance).

Psychotherapy is not always sufficient to resolve mental or emotional conditions. Psychiatric medication is sometimes needed. The reluctance to seek and use appropriate medication may contribute to worsening of symptoms or an increased risk for poor outcomes. In order to be successful, psychotherapy requires considerable personal motivation and investment in the process. This includes consistent attendance and attention to the treatment recommendations provided by the practitioner. Not all therapists are sufficiently qualified to work with all problems. The client or patient should seek referrals from trusted sources and should also inquire of the practitioner's training and background before committing to work with a particular therapist. Some forms of psychotherapy evoke strong emotional feelings and expression. This can be disturbing for people with serious mental illness or some medical conditions.

Avoid if allergic or sensitive to products containing selenium. Avoid in those with a history of nonmelanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.

Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Several studies report enhanced quality of life in those with cancer, less sleep disturbance, fewer stress symptoms, and changes in cancer-related immune cells after patients received relaxation, meditation and gentle yoga therapy. Yoga is not recommended as a sole treatment for cancer but may be helpful as an adjunct therapy.

Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses in those with disc disease of the spine, fragile or atherosclerotic neck arteries, a risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously in those with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction (the popular Lamaze techniques are based on yogic breathing). However, poses that put pressure on the uterus, such as abdominal twists, should be avoided during pregnancy.

Unclear or conflicting scientific evidence:

Acupuncture: Acupuncture, or the use of needles to manipulate "qi," or body energy, originated in China over 5,000 years ago. There has been limited research on acupuncture for cancer pain, and the research that was done was shown to have mixed results. More studies are needed to determine potential benefits. Evidence from several small studies supports use of acupuncture at a specific point on the wrist (P6) to help chemotherapy patients reduce nausea and vomiting. Acupuncture may also reduce the pain associated with cancer.

Early research suggests that acupuncture or electroacupuncture may help treat vasomotor symptoms, such as hot flashes, in breast cancer patients. More research is needed before a conclusion can be made.

Needles must be sterile in order to avoid disease transmission. Avoid in those with valvular heart disease, infections, or bleeding disorders, or with anticoagulants (drugs that increase the risk of bleeding), medical conditions of unknown origin, or neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously in those with pulmonary diseases (such as asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or those with a history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.

Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used on the skin for thousands of years to treat wounds, skin infections, burns, and numerous other skin conditions. Dried latex from the inner lining of the leaf has traditionally been used as an oral laxative. Preliminary research suggests that aloe may help in the area of cancer prevention or may aid in the regression of cancerous tumors. Additional research is needed in this area.

Caution is advised when taking aloe supplements, as numerous adverse effects, including a laxative effect, cramping, dehydration, and drug interactions, are possible. Aloe should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Alpha-lipoic acid: Alpha-lipoic acid (ALA) has not been well studied for pancreatic cancer in humans. High-quality studies are needed.

Avoid if allergic to ALA. Use cautiously in those with diabetes and thyroid diseases. Avoid in those with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.

American pawpaw: Evidence supporting the use of the American pawpaw (Asimina triloba) tree for cancer treatment in humans is largely anecdotal and subjective. However, use in humans has caused minimal side effects, and evidence from animal and test tube studies suggest that American pawpaw extract does have some anticancer activity. Pawpaw standardized extract has been used for 18 months in patients with various forms of cancer. Well-designed studies on the long-term effects of pawpaw extracts are currently lacking. Pawpaw should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Antineoplastons: Antineoplastons are a group of naturally occurring peptide fractions, which were observed to be absent in the urine of cancer patients by Stanislaw Burzynski, MD, PhD, in the late 1970s. There is inconclusive scientific evidence regarding the effectiveness of antineoplastons in the treatment of cancer. Several preliminary human studies (case series, phase I/II trials) have examined antineoplaston types A2, A5, A10, AS2-1, and AS2-5 for a variety of cancer types. It remains unclear if antineoplastons are effective, or what doses may be safe. Until better research is available, no clear conclusion can be drawn.

Avoid if allergic or hypersensitive to antineoplastons. Use cautiously in those with high medical or psychiatric risks, an active infection due to a possible decrease in white blood cells, high blood pressure, heart conditions, chronic obstructive pulmonary disease, liver disease or damage, or kidney disease or damage. Avoid if pregnant or breastfeeding.

Arabinoxylan: Arabinoxylan is made by altering the outer shell of rice bran using enzymes from Hyphomycetes mushroom mycelia extract. Arabinoxylan has been found to improve immune reactions in patients with diabetes and cancer of various types. Arabinoxylan products may contain high calcium and phosphorus levels, which may be harmful for patients with compromised renal (kidney) function.

Caution is advised when taking arabinoxylan supplements, as numerous adverse effects, including drug interactions, are possible. Arabinoxylan should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Arginine: It is unclear if arginine can help treat breast cancer patients. High-quality studies are needed.

A combination of arginine and omega-3 fatty acids may reduce the length of hospital stays and infections for patients after gastrointestinal cancer surgery. Other research suggests that arginine, omega-3 fatty acids, and glutamine may boost the immune system and reduce inflammation after surgery. More research with arginine alone is needed.

Avoid if allergic to arginine, or with a history of stroke or liver or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®), blood pressure drugs. or herbs or supplements with similar effects. Check blood potassium levels. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.

Aromatherapy: Healing with fragrant oils has been used for thousands of years. Aromatherapy is often used in people with chronic illnesses (frequently in combination with massage), with the intention to improve quality of life or well-being. There is currently not enough scientific evidence to form a firm conclusion about the effectiveness of aromatherapy for quality of life in those with cancer.

Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid in those with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils by mouth. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.

Art therapy: Art therapy involves the application of a variety of art modalities, including drawing, painting, clay, and sculpture. Art therapy enables the expression of inner thoughts or feelings when verbalization is difficult or not possible. Limited evidence suggests that art therapy may be of benefit in cancer caregiving. Possible benefits include reduced stress, lowered anxiety, increased positive emotions, and increased positive communication with cancer patients and healthcare professionals. Art therapy may also reduce pain and other symptoms in cancer patients. More studies are needed to determine how best to use this form of intervention with this population. Art therapy may also benefit children hospitalized with leukemia during and after painful procedures. Limited available research suggests that art therapy improves cooperation with treatment. Children requested art therapy again when the procedures were repeated, and parents reported that children were more manageable after art therapy.

Art therapy may evoke distressing thoughts or feelings. Use under the guidance of a qualified art therapist or other mental health professional. Some forms of art therapy use potentially harmful materials. Only materials known to be safe should be used. Related cleanup materials (like turpentine or mineral spirits) that release potentially toxic fumes should only be used with good ventilation.

Astragalus: Astragalus (Astragalus membranaceus) has been used in Chinese medicine for centuries for its immune-enhancing properties. Although early laboratory and animal studies report immune stimulation and reduced cancer cell growth associated with the use of astragalus, reliable human evidence in these areas is currently lacking. In Chinese medicine, astragalus-containing herbal mixtures are also sometimes used with the intention to reduce the side effects of chemotherapy and other cancer treatments. Astragalus-containing herbal combination formulas may also have beneficial effects in aplastic anemia. Due to a lack of well-designed research, a firm conclusion cannot be drawn.

Caution is advised when taking astragalus supplements, as numerous adverse effects, including drug interactions, are possible. Astragalus should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Baikal skullcap: Although the outcomes of early studies using Baikal skullcap for cancer are promising, high-quality clinical studies are needed in this area before a conclusion can be made. Avoid if allergic or hypersensitive to Baikal skullcap (Scutellaria barbata), its constituents, or members of the Lamiaceae family. Use cautiously if taking sedatives or operating heavy machinery. Use cautiously if taking antineoplastic (anticancer) agents or agents metabolized by cytochrome P450 enzymes. Avoid if pregnant or breastfeeding. Baikal skullcap is an ingredient in PC-SPES, a product that has been recalled from the U.S. market and that should not be used.

Bee pollen: Bee pollen is considered a highly nutritious food, because it contains a balance of vitamins, minerals, proteins, carbohydrates, fats, enzymes, and essential amino acids. Research has found that bee pollen may reduce some adverse effects of cancer treatment. Additional research is needed before a firm recommendation can be made.

Caution is advised when taking bee pollen supplements, as allergic reactions may occur in sensitive individuals. Bee pollen should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Beta-glucan: Treatment with a beta-glucan, also called lentinan, plus chemotherapy (S-1) may help prolong the lives of patients with cancer that has returned or cannot be operated on. More research is needed in this area.

Avoid if allergic or hypersensitive to beta-glucan. When taken by mouth, beta-glucan is generally considered safe. Use cautiously in those with AIDS or AIDS-related complex (ARC). Avoid using particulate beta-glucan. Avoid if pregnant or breastfeeding.

Bitter melon: Bitter melon (Momordica charantia) is used in Ayurvedic medicine from India to lower blood sugar levels. Research has also found that bitter melon extracts may be beneficial in cancer therapies. MAP30, a protein isolated from bitter melon extract, has been reported to possess anticancer effects in laboratory studies. Its potential anticancer effects have not been studied appropriately in humans.

Caution is advised when taking bitter melon supplements, as numerous adverse effects, including blood sugar lowering and drug interactions, are possible. Bitter melon should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Black cohosh: There is not enough human research to make a clear recommendation regarding the use of black cohosh for breast cancer.

Use cautiously if allergic to members of the Ranunculaceae family, such as buttercups or crowfoot. Avoid in those with hormone conditions (e.g., breast cancer, ovarian cancer, uterine cancer, or endometriosis). Avoid if allergic to aspirin products, nonsteroidal anti-inflammatory drugs (such as ibuprofen), or blood thinners (such as warfarin). Avoid in those with a history of blood clots, stroke, seizures, or liver disease. Stop use two weeks before and immediately after surgery, or dental or diagnostic procedures with bleeding risks.

Black tea: Black tea (Camellia sinensis) is from the same plant as green tea, but the leaves are processed differently. Black tea usually contains more caffeine than green tea. Several studies have explored a possible association between regular consumption of black tea and rates of cancer in several populations. This research has yielded conflicting results, with some studies suggesting benefits and others reporting no effects. Laboratory and animal studies report that components of tea, such as polyphenols, have antioxidant properties and effects against tumors. However, effects in humans remain unclear, and these components may be more common in green tea than in black tea. Some animal and laboratory research suggests that components of black tea may actually be carcinogenic, or cancer causing, although its effects in humans are not clear. Overall, the relationship of black tea consumption and human cancer prevention remains undetermined.

Although there is strong evidence from animal and laboratory studies that black tea may help prevent colorectal cancer, human studies are limited. Additional research is needed.

Avoid if allergic or hypersensitive to caffeine or tannins. Skin rash and hives have been reported with caffeine ingestion. Use caution with diabetes. Use cautiously if pregnant. Heavy caffeine intake during pregnancy may increase the risk of sudden infant death syndrome (SIDS). Very high doses of caffeine have been linked with birth defects. Caffeine is transferred into breast milk. Caffeine ingestion by infants can lead to sleep disturbances or insomnia. Infants nursing from mothers consuming greater than 500 milligrams of caffeine daily have been reported to experience tremors and heart rhythm abnormalities. Tea consumption by infants has been linked to anemia, decreased iron metabolism, and irritability.

Boswellia: Boswellia has been used as a cancer treatment, but there is not enough human data to support this use for brain tumors over standard therapies.

Boswellia is generally believed to be safe when used as directed, although its safety and toxicity have not been well studied in humans. Avoid if allergic to boswellia or similar herbs or if pregnant or breastfeeding.

Bovine cartilage: In early research, bovine tracheal cartilage preparations (such as Catrix® and VitaCarte®) have been studied for the treatment of cancer, with encouraging results. High-quality clinical research is needed to better determine the effectiveness of bovine tracheal cartilage preparations for cancer treatment.

Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously in those with cancer, renal (kidney) failure, or hepatic (liver) failure. Avoid if pregnant or breastfeeding.

Bromelain: Bromelain is a sulfur-containing digestive enzyme (proteins that help with digestion) that is extracted from the stem and the fruit of the pineapple plant (Ananas comosus). There is not enough information to recommend for or against the use of bromelain in the treatment of cancer, either alone or in addition to other therapies. One small study found that a bromelain supplement decreased tumor size in 12 breast cancer patients. Patients took the supplements for different periods of time, lasting from months to years.

Caution is advised when taking bromelain supplements, as numerous adverse effects, including blood thinning and drug interactions, are possible. Bromelain should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Bupleurum: Bupleurum is an herb that is typically found in East Asia. Hepatocellular carcinoma (HCC) arises predominantly in patients with cirrhosis, both hepatitis-associated and non-hepatitis-associated. Sho-saiko-to, the Japanese version of the classical bupleurum-based formula, has been examined for a possible role in preventing the development of HCC in patients with cirrhosis. Early research suggests that this formula may help prevent progression to HCC in patients with cirrhosis, although more research is needed.

Avoid if allergic or hypersensitive to bupleurum or any members of the Apiaceae or Umbelliferae (carrot) families. Use cautiously if driving or operating heavy machinery, because bupleurum may cause drowsiness. Use cautiously in those with diabetes, high blood pressure, or edema. Use cautiously if taking anticoagulants (drugs that increase the risk of bleeding).

Calcium: Calcium is the most abundant mineral in the human body and has several important functions. Most large prospective studies have found increased calcium intake to be only weakly associated with a decreased risk of colorectal cancer. Further studies are needed to verify these results. There is also a lack of agreement regarding the relationship between calcium intake and prostate cancer.

Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid in those with high levels of calcium in the blood, high levels of calcium in the urine, hyperparathyroidism (overgrowth of the parathyroid glands), bone tumors, digitalis toxicity, ventricular fibrillation (rapid, irregular twitching of the heart muscle), kidney stones, kidney disease, or sarcoidosis (inflammatory disease). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously in those with achlorhydria or irregular heartbeat. Talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.

Cat's claw: Originally found in Peru, the use of cat's claw (Uncaria tomentosa) has been said to date back to the Inca civilization, possibly as far back as 2,000 years. Cat's claw has anti-inflammatory properties, and several low-quality studies suggest that cat's claw may slow tumor growth. However, this research is early and has not identified specific types of cancer that may benefit; thus, the results are not clear. A few studies suggest that cat's claw may also boost the immune system.

Caution is advised when taking cat's claw supplements, as numerous adverse effects, including blood thinning and drug interactions, are possible. Cat's claw should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Chaparral: Chaparral was used by the Native Americans for various health conditions. The chaparral component nordihydroguaiaretic acid (NDGA) has been evaluated as a treatment for cancer, but due to a risk of toxicity, it is considered unsafe and not recommended for use. Chaparral and NDGA have been associated with cases of kidney and liver failure, liver cirrhosis, kidney cysts, and kidney cancer in humans. In response to these reports, the U.S. Food and Drug Administration (FDA) removed chaparral from its "generally recognized as safe" (GRAS) list in 1970. Chaparral and NDGA are generally considered unsafe and are not recommended for use.

Avoid if allergic to chaparral or any of its components, including nordihydroguaiaretic acid. Use cautiously if taking anticoagulants (blood thinners), blood sugar medication, or drugs that are broken down by the liver (like amiodarone, phenobarbital, valproic acid). Stop use two weeks before surgery or dental or diagnostic procedures with bleeding risks, and do not use immediately after these procedures. Use cautiously if driving or operating heavy machinery. Avoid if pregnant or breastfeeding.

Chelation therapy: During chelation therapy, ethylenediamine tetraacetic acid (EDTA), usually in combination with vitamins, trace elements, and iron supplements, is injected into the vein as a treatment for a variety of diseases. Early evidence shows that EDTA may be beneficial for patients with ovarian cancer when used as an adjunct to chemotherapy. However, further studies are needed before a strong recommendation can be made.

Avoid in patients taking warfarin. Avoid during root canal therapy. Chelation may be dangerous in people with heart, kidney, or liver disease, or those with conditions affecting blood cells or the immune system. Use during pregnancy, breastfeeding, or in children may also be dangerous due to potential toxic effects.

Chlorophyll: Preliminary evidence in suggest that chlorophyll may aid in the reduction of side effects associated with photodynamic therapies, such as those used in the management of malignant tumors. Further research is required to support the use of chlorophyll as a laser therapy adjunct for cancer treatment.

Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously in those with photosensitivity, compromised liver function, diabetes, or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or antidiabetes agents. Avoid if pregnant or breastfeeding.

Chrysanthemum: Early research indicates that hua-sheng-ping (which includes Chrysanthemum morifolium, Glycyrrhiza uralensis, and Panax notoginseng) may be beneficial for patients with precancerous lesions. However, more research is needed.

Avoid if allergic or hypersensitive to Chrysanthemum, its constituents, or members of the Asteraceae/Compositae family, such as dandelion, goldenrod, ragweed, sunflower, and daisies. Use cautiously if taking medication for gout, cancer, or HIV. Use cautiously in those with compromised immune systems or taking immunomodulators. Avoid in those with photosensitivity or taking photosensitizers. Avoid large acute or chronic doses of ingested pyrethrin. Avoid pyrethrin with compromised liver function, epilepsy, or asthma. Avoid ocular exposure to pyrethrin. Avoid if pregnant or breastfeeding.

Coenzyme Q10: Further research is needed to determine if coenzyme Q10 (CoQ10) may be of benefit for cancer patients when used with other therapies.

Allergy associated with coenzyme Q10 supplements has not been reported, although rash and itching have been reported rarely. Stop use two weeks before surgery or dental or diagnostic procedures with bleeding risks, and do not use immediately after these procedures. Use caution in those with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with anticoagulants (blood thinners), antiplatelet drugs (like aspirin, warfarin, clopidogrel (Plavix®)), or blood pressure, blood sugar, cholesterol, or thyroid drugs. Avoid if pregnant or breastfeeding.

Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, and fruits, as well as shellfish, avocado, and beef (organs such as liver). Preliminary research reports that lowering copper levels theoretically may arrest the progression of cancer by inhibiting angiogenesis (blood vessel growth). Copper intake has not been identified as a risk factor for the development or progression of cancer.

Copper is potentially unsafe when used orally in higher doses than the recommended dietary allowance (RDA). Copper supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Cranberry: Several laboratory studies have reported positive effects of proanthocyanidins, flavonoid components of cranberry (Vaccinium macrocarpon) and other fruits such as blueberries, grape seed, and pomegranate, on health. Based on early laboratory research, cranberry has been proposed for cancer prevention. Additional research is needed in humans before a conclusion can be made.

Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect blood sugar levels. Use cautiously in those with a history of kidney stones. Avoid more than the amount usually found in foods if pregnant or breastfeeding.

Dandelion: Limited animal research does not provide a clear assessment of the effects of dandelion on tumor growth. Well-conducted human studies are needed to better determine dandelion's effects on cancer.

Avoid if allergic to chamomile, feverfew, honey, yarrow, or any related plants, such as aster, daisies, sunflower, chrysanthemum, mugwort, ragweed, or ragwort. Use cautiously in those with diabetes, bleeding disorders, gastroesophageal reflux disease (GERD), kidney or liver diseases, or a history of stroke or electrolyte disorders. Monitor potassium blood levels. Stop use two weeks before surgery or dental or diagnostic procedures with bleeding risks, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.

Devil's claw: Devil's claw is used to treat several types of pain, including osteoarthritis and low back pain. Case studies indicate that it may also be helpful for pain due to bone metastases. More research is needed.

Avoid if allergic to devil's claw or to plants in the Harpagophytum procumbens family. Use caution with stomach ulcers; a history of bleeding disorders, diabetes, gallstones, gout, heart disease, stroke, or ulcers; or with prescription drugs used for these conditions. Stop use two weeks before surgery or dental or diagnostic procedures with bleeding risks, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.

DHEA: Initial research reports that the use of intravaginal DHEA may be safe and may promote regression of low-grade cervical cancer lesions. However, further research is necessary.

Avoid if allergic to DHEA. Avoid in those with a history of seizures. Use with cautiously in those with adrenal or thyroid disorders. Use cautiously if taking anticoagulants or drugs, herbs, or supplements for diabetes, heart disease, seizures, or stroke. Stop use two weeks before and immediately after surgery or dental or diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.

Echinacea: There is currently a lack of clear human evidence that echinacea affects any type of cancer. The evidence from a small number of clinical trials evaluating the efficacy of echinacea in the treatment of radiation-induced leukopenia (a decrease in white blood cells) is equivocal. Studies have used the combination product Esberitox®, which includes extracts of echinacea (Echinacea purpurea and Echinacea pallida) root, white cedar (Thuja occidentalis) leaf, and wild indigo (Baptisia tinctoria)root. Additional clinical studies are needed to make a conclusion.

Caution is advised when taking echinacea supplements, as numerous adverse effects, including drug interactions, are possible. Echinacea should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Essiac®: Essiac® contains a combination of herbs, including burdock root (Arctium lappa), sheep sorrel (Rumex acetosella), slippery elm inner bark (Ulmus fulva), and Turkish rhubarb (Rheum palmatum). The original formula was developed by the Canadian nurse Rene Caisse (1888-1978) and is thought to be effective in cancer therapies, although currently there is not enough evidence to recommend for or against the use of this herbal mixture as a therapy for any type of cancer. Different brands may contain variable ingredients, and the comparative effectiveness of these formulas is not known. None of the individual herbs used in Essiac® has been tested in rigorous human cancer trials, although some components had antitumor activity in laboratory studies. Numerous individual patient testimonials and reports from manufacturers are available on the Internet, although these cannot be considered scientifically viable as evidence. Individuals with cancer are advised not to delay treatment with more proven therapies.

Caution is advised when taking Essiac® supplements, as numerous adverse effects, including drug interactions, are possible. Essiac® should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Evening primrose oil: Not enough information is available to advise the use of evening primrose oil for breast cancer.

Avoid if allergic to plants in the Onagraceae family (willow's herb, enchanter's nightshade) or gamma-linolenic acid. Avoid in those with seizure disorders. Use cautiously in those with mental illness drugs. Stop use two weeks before surgery with anesthesia. Avoid if pregnant or breastfeeding.

Flaxseed and flaxseed oil: Flaxseed and flaxseed oil (linseed oil) are rich sources of the essential fatty acid alpha-linolenic acid (omega-6). There is a lack of information from human studies that flaxseed, rather than flaxseed oil, is effective in preventing or treating breast cancer or prostate cancer.

Flaxseed has been well tolerated in studies for up to four months. Avoid if allergic to flaxseed, flaxseed oil, or other plants of the Linaceae family. Avoid ingestion of immature flaxseed pods. Avoid large amounts of flaxseed by mouth, and mix with plenty of water or liquid. Avoid flaxseed (not flaxseed oil) with a history of esophageal stricture, ileus, gastrointestinal stricture, or bowel obstruction. Avoid in those with history of acute or chronic diarrhea, irritable bowel syndrome (IBS), diverticulitis, or inflammatory bowel disease. Avoid topical flaxseed in open wounds or on abraded skin surfaces. Use cautiously in those with history of bleeding disorders or with drugs that increase the risk of bleeding (like anticoagulants and nonsteroidal anti-inflammatory drugs). Use cautiously in those with high triglyceride levels, diabetes, mania, seizures, or asthma. Avoid if pregnant or breastfeeding.

Focusing: Focusing (experiential therapy) is a method of psychotherapy that involves being aware of one's feelings surrounding a particular issue and understanding the meaning behind words or images conveyed by those feelings. Early evidence suggests that focusing may improve mood and attitude in cancer patients. Firm recommendations cannot be made until well-designed clinical trials are available.

Side effect reporting is rare, but patients should consult with a qualified healthcare practitioner before making decisions about medical conditions and practices. Individuals with severe emotional difficulties should not abandon proven medical and psychological therapies but rather choose focusing as a possible adjunct.

Folate: Folic acid, or folate, is a form of a water-soluble B vitamin needed for human health. Preliminary evidence suggests that folate may decrease the risk of several types of cancer. Additional research is needed to make a conclusion. Folic acid supplementation may mask the symptoms of pernicious, aplastic, or normocytic anemias caused by vitamin B12 deficiency and may lead to neurological damage.

Avoid if allergic or hypersensitive to folate or any folate product ingredients. Use cautiously if receiving coronary stents and with anemia and seizure disorders. It is recommended that pregnant women consume 400 micrograms daily in order to reduce the risk of fetal defects. Folate is likely safe if breastfeeding.

Gamma-linolenic acid (GLA): GLA is an omega-6 essential fatty acid. Some laboratory and human studies indicate that GLA may have antitumor activity and may be used as a cancer treatment adjunct. Additional research is needed in this area.

Caution is advised when taking GLA supplements, as numerous adverse effects, including an increased risk of bleeding and drug interactions, are possible. GLA should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Garlic: Preliminary human studies suggest that regular consumption of garlic (Allium sativum) supplements may reduce the risk of developing several types of cancer. Some studies use multi-ingredient products, so it is difficult to determine if garlic alone may play a beneficial role in cancer prevention. Further well-designed human clinical trials are needed to conclude whether eating garlic or taking garlic supplements may prevent or treat cancer.

Caution is advised when taking garlic supplements, as numerous adverse effects, including an increased risk of bleeding and drug interactions, are possible. Garlic should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Ginkgo: Ginkgo biloba exocarp polysaccharides (GBEP) capsule preparations have been studied for upper digestive tract malignant tumors of middle and late stages, with positive results. However, further research is needed to better understand the potential role of ginkgo for gastric cancer.

Avoid if allergic or hypersensitive to members of the Ginkgoaceaefamily.
If allergic to mango rind, sumac, poison ivy or oak, or cashews, then allergy to ginkgo is possible. Avoid in those taking blood thinners (like aspirin or warfarin (Coumadin®)), due to an increased risk of bleeding. Ginkgo should be stopped two weeks before surgical procedures. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur. Do not use ginkgo in supplemental doses if pregnant or breastfeeding.

Ginseng: Early studies report that ginseng taken by mouth may be of benefit in cancer prevention, especially if ginseng powder or extract is used. Weak studies suggest that ginseng in combination with other herbs may improve cell activity, immune function, and red and white blood cell counts in patients with aplastic anemia. However, other studies have found decreases in blood cell counts. Early studies suggest that ginseng may decrease radiation therapy side effects and may be used as a chemotherapy adjunct to improve body weight, quality of life, and the immune response. There is currently not enough evidence to recommend the use of Panax ginseng or American ginseng for these indications. Research results are unclear, and more research is needed before a clear conclusion can be reached.

Caution is advised when taking ginseng supplements, as numerous adverse effects, including an increased risk of drug interactions, are possible. Ginseng should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Goji: Polysaccharide constituents, such as alpha- and beta-glucans from a variety of plants, have been reported to have immune system-enhancing properties. In clinical research, Lycium barbarum polysaccharides (LBP) demonstrated a synergistic effect in various cancer treatments, when administered in conjunction with powerful immune-stimulating drugs.

Use cautiously in patients taking blood-thinning medications, such as warfarin. Use cautiously in asthma patients and in patients with sulfite sensitivities. The New York Department of Agriculture has detected the presence of undeclared sulfites, a food additive, in two dried goji berry products from China. Avoid in patients who are allergic to goji, any of its constituents, or to members of the Solanaceae family.

Grape seed: There is currently little information available on the use of grape seed extract in the treatment of human cancer. Further research is needed before a recommendation can be made.

Avoid if allergic or hypersensitive to grapes or other grape compounds. Use cautiously in those with bleeding disorders or if taking blood thinners such as warfarin, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDS), or antiplatelet agents. Use cautiously with drugs processed using the liver's cytochrome P450 enzyme system. Use cautiously in those with blood pressure disorders or if taking ACE inhibitors. Avoid if pregnant or breastfeeding.

Greater celandine: The majority of studies on the use of Chelidonium majus in the treatment of various types of cancer, such as esophageal cancer, lung cancer, and pancreatic cancer, utilized the semisynthetic drug UkrainTM. Additional research is needed to better understand the role of this agent in patients with cancer.

Use cautiously in patients taking amphetamines, morphine, hexobarbital, MAOIs, or dopaminergic or serotonergic drugs, or in patients undergoing radiation therapy. Avoid in patients with liver disease or in pregnant and lactating women.

Green tea: Green tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. Green tea has a long history of use in health and longevity, dating back to China approximately 5,000 years ago. Although used for centuries to help prevent diseases, the relationship of green tea consumption and human cancer in general remains inconclusive. Evidence from well-designed clinical trials is needed before a firm conclusion can be made in this area.

Caution is advised when taking green tea supplements, as numerous adverse effects, including an increased risk of drug interactions, are possible. Green tea should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Healing touch: Preliminary data suggest that healing touch (HT) may increase quality of life in cancer patients. However, due to weaknesses in design and the small number of studies, the data are insufficient to make definitive recommendations. Studies with stronger designs are needed.

HT should not be regarded as a substitute for established medical treatments. Use cautiously if pregnant or breastfeeding.

Hoxsey formula: "Hoxsey formula" is a misleading name, because it is not a single formula, but rather a therapeutic regimen consisting of an oral tonic, topical (on the skin) preparations, and supportive therapy. The tonic is individualized for cancer patients based on their general condition, the location of the cancer, and any previous history of treatment. An ingredient that usually remains constant for every patient is potassium iodide. Other ingredients are then added and may include licorice, red clover, burdock, stillingia root, berberis root, pokeroot, cascara, Aromatic USP 14, prickly ash bark, and buckthorn bark. A red paste may be used, which tends to be caustic (irritating) and contains antimony trisulfide, zinc chloride, and bloodroot. A topical yellow powder may be used, and it contains arsenic sulfide, talc, sulfur, and a "yellow precipitate." A clear solution may also be administered, and it contains trichloroacetic acid.

Well-designed human studies evaluating the safety or effectiveness of Hoxsey formula are currently lacking. Caution is advised when taking the Hoxsey formula supplements, as numerous adverse effects, including an increased risk of drug interactions, are possible. Hoxsey formula should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Hydrazine sulfate: Hydrazine is an industrial chemical marketed as having the potential to repress weight loss and cachexia (muscle wasting) associated with cancer, and to improve general appetite status. However, in large randomized controlled trials, hydrazine has not been proven effective for improving appetite, reducing weight loss, or improving survival in adults. The National Cancer Institute (NCI) sponsored studies of hydrazine sulfate that claimed efficacy in improving survival for some patients with advanced cancer. Trial results found that hydrazine sulfate did not prolong survival for cancer patients. The U.S. Food and Drug Administration (FDA) has received requests from individual physicians for approval to use hydrazine sulfate on a case-by-case "compassionate use" basis on the chance that patients with no other available effective cancer treatment options might benefit from this therapy. The overall controversy in the use of hydrazine sulfate is ongoing, and its relevance to clinical practice is unknown. The use of hydrazine sulfate needs to be evaluated further before any recommendations can be made.

Hydrazine sulfate may cause cancer. Avoid if allergic or hypersensitive to hydrazine sulfate or any of its constituents. Use cautiously in those with liver or kidney problems, psychosis, diabetes, or seizure disorders. Avoid if pregnant or breastfeeding. Side effects have been reported, including dizziness, nausea, and vomiting.

Iodine: Iodine is an element (atomic number 53) that is required by humans for the synthesis of thyroid hormones (triiodothyronine (T3) and thyroxine (T4)). The potential role of nonradioactive iodine in cancer care remains unknown. Antioxidant and antitumor effects have been proposed, based on laboratory research. In contrast, some scientists have asserted that tumors may uptake more iodine than normal tissues. It has been suggested that high rates of gastric (stomach) cancer or low rates of breast cancer in coastal Japan may be due to high iodine intake, although this has not been demonstrated scientifically. Povidone-iodine solutions have been used as a part of alternative cancer regimens, such as the Hoxsey formula. Preliminary research has also indicated povidone-iodine solution as a potential rectal washout for rectal cancer. Overall, no clear conclusion can be drawn based on the currently available evidence.

Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin, because it may irritate or burn tissues. Use sodium iodide cautiously in those with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.

Jiaogulan: Preliminary evidence indicates that gypenosides extracted from Gynostemma pentaphyllum may decrease cancer cell viability, arrest the cell cycle, and induce apoptosis (cell death) in human cancer cells. Immune function in cancer patients has also been studied. Additional research is needed in this area.

Avoid if allergic or hypersensitive to jiaogulan (Gynostemma pentaphyllum), its constituents, or members of the Cucurbitaceae family. Use cautiously in those with blood disorders or taking anticoagulants or antiplatelet drugs (blood thinners). Use cautiously in those with diabetes. Avoid if pregnant or breastfeeding.

Lavender: Perillyl alcohol (POH), derived from lavender (Lavandula officinalis), may be beneficial in the treatment of some types of cancer. Preliminary small studies in humans involving the use of POH suggested its safety and tolerability, but its effectiveness has not been established.

Avoid if allergic or hypersensitive to lavender. Avoid in those with a history of seizures, bleeding disorders, eating disorders (anorexia, bulimia), or anemia (low levels of iron). Avoid if pregnant or breastfeeding.

Lutein: Currently, there is insufficient available evidence to recommend for or against the use of lutein for cancer. Available evidence in humans is conflicting.

Avoid if allergic or hypersensitive to lutein or zeaxanthin. Use cautiously if at risk for cardiovascular disease or cancer. Avoid if pregnant or breastfeeding.

Lycopene: High levels of lycopene are found in tomatoes and in tomato-based products. Tomatoes are also sources of other nutrients, such as vitamin C, folate, and potassium. Several laboratory and human studies examining tomato-based products and blood lycopene levels suggest that lycopene may be associated with a lower risk of developing cancer and may help stimulate the immune system. Studies have been conducted on the use of lycopene for prevention of breast cancer, upper gastrointestinal tract and colorectal cancer, cervical cancer, lung cancer, ovarian cancer, and prostate cancer. However, due to a lack of well-designed human research using lycopene supplements, its effectiveness for cancer prevention remains unclear.

Avoid if allergic to tomatoes or to lycopene. Due to a lack of conclusive data, avoid if pregnant or breastfeeding.

Maitake mushroom: Maitake is the Japanese name for the edible mushroom Grifola frondosa. Maitake has been used traditionally both as a food and for medicinal purposes. Early studies in the laboratory as well as in humans suggest that beta-glucan extracts from maitake may increase the body's ability to fight cancer. However, these studies have not been well designed, and better research is needed before the use of maitake for cancer can be recommended.

Caution is advised when taking maitake supplements, as numerous adverse effects, including an increased risk of bleeding and drug interactions, are possible. Maitake should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Meditation: Not enough research has shown meditation to be of benefit in cancer prevention. More studies are needed.

Use cautiously in those with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professional(s) before starting a program of meditation and should explore how meditation may or may not fit in with their current treatment plan. Avoid in those with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies and should not be used as the sole approach to illnesses.

Melatonin: There are several early-phase and controlled human trials of melatonin in patients with various advanced-stage malignancies. There is currently not enough definitive scientific evidence to discern if melatonin is beneficial as a cancer treatment, whether it increases (or decreases) the effectiveness of other cancer therapies, or if it safely reduces chemotherapy side effects.

Melatonin is not to be used for extended periods of time. Caution is advised when taking melatonin supplements, as numerous adverse effects, including drug interactions, are possible. Melatonin is not recommended during pregnancy or breastfeeding unless otherwise advised by a doctor.

Milk thistle: Milk thistle (Silybum marianum) has been used medicinally in China for over 2,000 years, most commonly for the treatment of liver and gallbladder disorders. There are early reports from laboratory experiments that the components silymarin and silibinin found in milk thistle may reduce the growth of human cancer cells. However, these effects have not been shown in high-quality human trials.

Caution is advised when taking milk thistle supplements, as numerous adverse effects, including an increased risk of bleeding and drug interactions, are possible. Milk thistle should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Mistletoe: Mistletoe is one of the most widely used unconventional cancer treatments in Europe. Mistletoe extracts have been studied for a variety of human cancers, as well as melanoma and leukemia. However, its efficacy has not been conclusively proven for any one condition. In fact, some studies have shown lack of efficacy of certain preparations for a variety of cancers. Larger, well-designed clinical trials are needed.

Caution is advised when taking mistletoe supplements, as numerous adverse effects, including nausea, vomiting, and drug interactions, are possible. Mistletoe should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Modified citrus pectin: Modified citrus pectin (MCP) may reduce the metastasis of certain types of cancers, including lung, breast and prostate cancer. More research is needed.

Avoid if allergic or hypersensitive to modified citrus pectin. MCP may cause gastrointestinal discomfort in patients allergic or sensitive to MCP. Use cautiously if taking chelating medications or if under treatment for cancer. Use cautiously if taking oral drugs, herbs or supplements, as MCP may reduce or slow their absorption. Use cautiously in geriatric patients or patients with gastrointestinal disorders. Avoid if pregnant or breastfeeding, due to a lack of scientific data.

Moxibustion: Moxibustion is a healing technique employed across the diverse traditions of acupuncture and Oriental medicine for over 2,000 years. Moxibustion uses the principle of heat to stimulate circulation and break up congestion or stagnation of blood and qi. Moxibustion is closely related to acupuncture, as it is applied to specific acupuncture points. Preliminary evidence suggests that moxibustion may reduce side effects of chemotherapy or radiation therapy. More studies are needed.

Use cautiously over large blood vessels and thin or weak skin. Avoid in those with aneurysms, any kind of "heat syndrome," cardiac disease, convulsions or cramps, diabetic neuropathy, extreme fatigue and/or anemia, fever, or inflammatory conditions, and over allergic skin conditions, ulcerated sores, or skin adhesions. Avoid if pregnant or breastfeeding. Avoid areas with an inflamed organ, contraindicated acupuncture points, the face, the genitals, the head, inflamed areas in general, and the nipples. Avoid in patients who have just finished exercising or taking a hot bath or shower. Use cautiously in elderly people with large vessels. It is considered not advisable to bathe or shower for up to 24 hours after a moxibustion treatment.

Oleander: Laboratory studies of oleander (Nerium oleander) suggest possible anticancer effects, although reliable research in humans is not currently available. There are reports that long-term use of oleander may have positive effects on several types of cancer. More research is needed.

Caution is advised when taking oleander supplements, as numerous adverse effects, including drug interactions, are possible. Oleander should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Omega-3 fatty acids: Omega-3 fatty acids are essential fatty acids found in some plants and fish. A balance of omega-6 and omega-3 fatty acids is advised for health. Several population studies report that dietary omega-3 fatty acids or fish oil may reduce the risk of developing several different types of cancer. Well-conducted clinical trials are necessary before a clear conclusion can be drawn regarding the use of omega-3 fatty acids for cancer prevention.

Caution is advised when taking omega-3 fatty acid supplements, as numerous adverse effects, including an increase in bleeding and drug interactions, are possible. Omega-3 fatty acid supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Para-aminobenzoic acid(PABA): N-butyl-p-aminobenzoate (BAB) has been shown to be a lipid-soluble local anesthetic. Early research has found significant pain relief in patients with intractable cancer pain after an epidural injection of BAB suspension. Larger-scale clinical research is needed to confirm these findings.

Avoid in those with known hypersensitivity to PABA or its derivatives. Avoid oral use in children and pregnant or nursing women. Use cautiously in patients with renal disease or bleeding disorders, or those taking anticoagulants, diabetics, or patients at risk for hypoglycemia. Discontinue use if rash, nausea, or anorexia occurs. Pharmaceutical doses of PABA and its derivatives should only be taken under appropriate medical supervision. PABA should not be given concurrently with sulfonamides.

PC-SPES: Studies of PC-SPES® have reported improvements in patients with prostate cancer. Overall, these studies found that prostate-specificantigen (PSA) levels fell by greater than 50% in most patients. They also found improvements in bone scans and X-rays, reductions in pain scores, and improvements in quality of life. In addition, PC-SPES® extracts were reported to cause apoptosis (cell death) or to slow the growth of cancer cell lines. Because of these complicated circumstances, and the fact that PC-SPES® has never been compared to placebo or standard cancer treatments in a well-reported study, the question of its effectiveness remains unclear.

PC-SPES® has been recalled from the U.S. market and should not be used. Based on safety concerns associated with PC-SPES®, no dosage is recommended.

Peony: Although not well-studied in humans, peony may have anticancer activity. More high-quality studies are needed regarding the use of peony for lung cancer.

Avoid if allergic or sensitive to peony. Avoid in those with bleeding disorders or taking drugs, herbs, or supplements that increase bleeding risk. Use cautiously in those with estrogen-sensitive cancers or taking drugs, herbs, or supplements with hormonal activity. Avoid if pregnant or breastfeeding.

Perillyl alcohol: Perillyl alcohol has been used to treat cancer. However, high-quality scientific studies are lacking. Further research is required before recommendations can be made.

Avoid if allergic or hypersensitive to perillyl alcohol. Avoid use in the absence of medical supervision. Use cautiously in patients under medical supervision. Avoid if pregnant or breastfeeding.

Podophyllum: Preliminary evidence suggests that podophyllum may inhibit the growth of cancer cells and may be beneficial as an adjunct to radiation for uterine cancer. Further research is needed.

Avoid if allergic or hypersensitive to podophyllum or members of the Berberidaceae family. Podophyllum, when applied topically, may be absorbed through the skin and cause irritation of the stomach and intestines. Podophyllum toxicity may cause heart palpitations and blood pressure changes, muscle paralysis, difficulty walking, confusion, and convulsions. Using both podophyllum and laxatives may result in dehydration and electrolyte depletion. Use cautiously in those with arrhythmia, Crohn's disease, cardiovascular problems, gallbladder disease or gallstones, high blood pressure, irritable bowel syndrome, liver insufficiency, muscular disorders, neurologic disorders, psychosis, or kidney insufficiency. Use cautiously if taking antimitotic agents like vincristine, antipsychotic agents, or laxatives. Avoid if pregnant or breastfeeding.

Pomegranate: Consumption of pomegranate juice may be beneficial to patients with prostate cancer. Although early research is promising, more research is needed to a make a strong recommendation.

Avoid if allergic or hypersensitive to pomegranate. Avoid in those with diarrhea or high or low blood pressure. Avoid taking pomegranate fruit husk with oil or fats to treat parasites. Pomegranate root or stem bark should only be used under the supervision of a qualified healthcare professional. Use cautiously in those with liver damage or liver disease. Pomegranate supplementation may be unsafe during pregnancy when taken by mouth. The bark, root, and fruit rind may cause menstruation or uterine contractions. Avoid if breastfeeding, due to a lack of scientific data.

Prayer: Initial studies of prayer in patients with cancer (such as leukemia) report variable effects on disease progression or death rates, when intercessory prayer is used. Better-quality research is necessary before a firm conclusion can be drawn.

Prayer is not recommended as the sole treatment approach for potentially serious medical conditions, and it should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches, and this requires an open dialog between patients and caregivers. In clinical research, patients certain that they were receiving intercessory prayer had a higher incidence of complications following cardiac bypass surgery than those who did not know they were being prayed for.

Avoid if allergic or hypersensitive to PSK, Coriolus versicolor, or any of its ingredients. Use cautiously in those with coronary artery disease. Avoid if pregnant or breastfeeding.

Psyllium: Psyllium, also referred to as ispaghula, is derived from the husks of the seeds of Plantago ovata. According to early research, diets that include psyllium may reduce the risk of colon cancer. More studies are needed.

Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantains (Plantago lanceolata). Avoid in patients with esophageal disorders, gastrointestinal atony, fecal impaction, gastrointestinal tract narrowing, swallowing difficulties, and previous bowel surgery. Avoid ingestion of psyllium-containing products in individuals with repeated or prolonged psyllium exposure who have not shown allergic or hypersensitive symptoms. Prescription drugs should be taken one hour before or two hours after psyllium. Adequate fluid intake is required when taking psyllium-containing products. Use cautiously with blood thinners, antidiabetic agents, carbamazepine, lithium, potassium-sparing diuretics, salicylates, tetracyclines, nitrofurantoin, calcium, iron, vitamin B12, other laxatives, tricyclic antidepressants (amitriptyline, doxepin, and imipramine), antigout agents, anti-inflammatory agents, hydrophilic agents, and chitosan. Use cautiously in those with diabetes and kidney dysfunction. Use cautiously if pregnant or breastfeeding.

Quercetin: Quercetin is a major flavonol (antioxidant) that occurs in foods of plant origin. Some research suggests that quercetin may help with pancreatic cancer prevention in smokers. However, quercetin did not have this effect in nonsmokers or former smokers. More research is needed.

Quercetin is generally considered safe when taken at doses normally found in foods. Avoid if allergic or hypersensitive to quercetin. Possible eye, skin, gastrointestinal, or respiratory tract infection can occur. Avoid if pregnant or breastfeeding, due to a lack of evidence.

Red clover: Red clover isoflavones may have estrogen-like properties in the body, and have been proposed as a possible therapy in prostate cancer and related hot flashes. Some isoflavones have also been shown in laboratory studies to have anti-cancer properties. Because well designed human research is lacking in this area, a recommendation cannot be made for prostate cancer prevention.

Avoid if allergic to red clover or other isoflavones. Use cautiously with hormone replacement therapy (HRT) or birth control pills. Use cautiously with history of a bleeding disorder, breast cancer or endometrial cancer. Use cautiously with drugs that thin the blood. Avoid if pregnant or breastfeeding.

Reiki: Reiki may contribute to reduced perception of pain, improved quality of life, and reduced fatigue in cancer patients. More studies are needed.

Reiki is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Use cautiously in those with psychiatric illnesses.

Reishi mushroom: Reishi (Ganoderma lucidum) has been shown to have antineoplastic and immunomodulatory effects in animal studies. Human studies exist of advanced cancer patients using Ganopoly®, a Ganoderma lucidum polysaccharide extract. The results show improved quality of life and enhanced immune responses, which are typically reduced or damaged in cancer patients receiving chemotherapy and/or radiation therapy. Well-designed long-term studies are needed confirm these results and to determine potential side effects.

Caution is advised when taking reishi supplements, as numerous adverse effects, including an increased risk of bleeding and drug interactions, are possible. Reishi should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Resveratrol: The effects of resveratrol cannot be adequately assessed from trials using foods, wine, or combination products containing resveratrol and other substances. Well-designed clinical trials of resveratrol alone are needed before a recommendation can be made in regard to cancer prevention and treatment.

Avoid if allergic or hypersensitive to resveratrol, grapes, red wine, or polyphenols. Resveratrol is generally considered safe and is commonly found in food and beverages. Use cautiously in those with bleeding disorders or abnormal blood pressure. Use cautiously with drugs that are broken down by the body's cytochrome P450 system, digoxin, or digoxin-like drugs. Avoid if pregnant or breastfeeding.

Rhodiola: Early evidence suggests that Rhodiola may decrease the spread of bladder cancer and increase survival. More evidence is needed.

Avoid if allergic or sensitive to Rhodiola. Use cautiously in people with diabetes, cardiovascular disease, or neurological or psychiatric disorders. Rhodiola is not recommended for use during pregnancy or breastfeeding.

Riboflavin: Riboflavin (vitamin B2) is a water-soluble vitamin that is involved in vital metabolic processes in the body and is necessary for normal cell function, growth, and energy production. Riboflavin supplementation has been studied in the prevention and treatment of esophageal cancer, mostly in China, with mixed results. No clear conclusion can be drawn at this time.

Avoid if allergic or hypersensitive to riboflavin. Since the amount of riboflavin a human can absorb is limited, riboflavin is generally considered safe. Riboflavin is generally regarded as safe during pregnancy and breastfeeding.

Sage: Sage used daily as a spice in foods in the Mediterranean diet has been associated with a lower risk of lung cancer. Reliable human studies are currently lacking.

Avoid if allergic or hypersensitive to sage species, their constituents, or to members of the Lamiaceae family. Use cautiously in those with hypertension (high blood pressure). Use the essential oil or tinctures cautiously in patients with epilepsy. Avoid in those with previous anaphylactic reactions to sage species, their constituents, or to members of the Lamiaceae family. Avoid if pregnant or breastfeeding.

Saw palmetto: There is not enough scientific evidence to recommend the product PC-SPES® (which contains saw palmetto) for prostate cancer. PC-SPES® also contains seven other herbs (Chrysanthemum morifolium, Isatis indigotica, Glycyrrhiza glabra, Ganoderma lucidum, Panax pseudo-ginseng, Rabdosia rubescens, and Scutellaria baicalensis). It has been a popular treatment for prostate cancer, but the U.S. Food and Drug Administration (FDA) has issued a warning not to use PC-SPES® because it contains the anticoagulant chemical warfarin and may cause bleeding.

Avoid if allergic or hypersensitive to saw palmetto. Use cautiously in those with a history of health conditions involving the stomach, liver, heart, or lungs; hormone-sensitive conditions; or bleeding disorders. Use cautiously with drugs that thin the blood, hormonal drugs, or birth control pills. Avoid if pregnant, possibly pregnant, or thinking about becoming pregnant. Avoid if breastfeeding.

Seaweed: Bladderwrack (Fucus vesiculosus) is a brown seaweed that grows on the northern coasts of the Atlantic and Pacific Oceans and the North and Baltic Seas. Bladderwrack appears to suppress the growth of various cancer cells in animal and laboratory studies. However, reliable human studies to support a recommendation for use in cancer are currently lacking.

Caution is advised when taking bladderwrack supplements, as numerous adverse effects, including an increased risk of drug interactions, are possible. Bladderwrack should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Selenium: Selenium is a trace mineral found in soil, water, and some foods. It is an essential element in several metabolic pathways. Several studies suggest that low levels of selenium (measured in the blood or in tissues such as toenail clippings) may be a risk factor for developing cancer. Population studies suggest that people with cancer are more likely to have low selenium levels than healthy matched individuals, but in most cases, it is not clear if the low selenium levels are a cause or merely a consequence of disease. It currently remains unclear if selenium is beneficial for cancer prevention or cancer treatment.

Avoid if allergic or sensitive to products containing selenium. Avoid in those with a history of nonmelanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.

Shark cartilage: For several decades, shark cartilage has been proposed as a cancer treatment. Studies have shown shark cartilage or the shark cartilage product AE-941 (Neovastat®) to block the growth of new blood vessels, a process called "antiangiogenesis," which is believed to play a role in controlling growth of some tumors. There have also been several reports of successful treatments of end-stage cancer patients with shark cartilage, but these have not been well-designed and have not included reliable comparisons to accepted treatments. Many studies have been supported by shark cartilage product manufacturers, which may influence the results. In the United States, shark cartilage products cannot claim to cure cancer, and the U.S. Food and Drug Administration (FDA) has sent warning letters to companies not to promote products in this way. Without further evidence from well-designed human trials, it remains unclear if shark cartilage is of any benefit in cancer, and patients are advised to check with their doctor and pharmacist before taking shark cartilage.

Shark cartilage available in Asian grocery stores and restaurants should not be eaten due to declining populations of sharks. Caution is advised when taking shark cartilage supplements, as numerous adverse effects, including an increased risk of drug interactions, are possible. Shark cartilage should not be used by patients who are pregnant or breastfeeding, unless otherwise directed by a doctor.

Shiitake mushroom: Shiitake (Lentinus edodes) has been taken by mouth for boosting the immune system, decreasing cholesterol levels, and antiaging. Lentinan, derived from shiitake, has been injected as an adjunct treatment for cancer and HIV infection. Laboratory, animal, and human studies of lentinan have shown positive results in cancer patients when used as a chemotherapy adjunct. Further well-designed clinical trials on all types of cancer are required to confirm these results.

Caution is advised when taking shiitake supplements, as numerous adverse effects, including an increased risk of bleeding and drug interactions, are possible. Shiitake should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Slippery elm: Slippery elm is found as a common ingredient in a purported herbal anticancer product called Essiac® and a number of Essiac®-like products. These products contain other herbs, such as rhubarb, sorrel, and burdock root. Currently, there is not enough evidence to recommend for or against the use of this herbal mixture as a therapy for any type of cancer. Avoid if allergic or hypersensitive to slippery elm. Avoid if pregnant or breastfeeding.

Sorrel: Early evidence suggests that herbal formulations containing sorrel, such as Essiac®, do not shrink tumor size or increase life expectancy in patients with cancer. However, currently there is a lack of studies evaluating sorrel as the sole treatment for cancer. A conclusion cannot be made without further research.

Avoid with a known allergy or hypersensitivity to sorrel. Avoid large doses, due to reports of toxicity and death, possibly because of the oxalate found in sorrel. Many tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. Sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl®) or disulfiram (Antabuse®). Avoid if pregnant or breastfeeding.

Soy: Soy (Glycine max) contains compounds that have been reported to be effective as a cancer treatment. Genistein, an isoflavone found in soy, has been found in laboratory and animal studies to possess anticancer effects, such as blocking new blood vessel growth (called antiangiogenesis), acting as a tyrosine kinase inhibitor (a mechanism of many new cancer treatments), or causing cancer cell death (called apoptosis). In contrast, genistein has also been reported to increase the growth of pancreas tumor cells in laboratory research. Until reliable human research is available, it remains unclear if dietary soy or soy isoflavone supplements are beneficial, harmful, or neutral in people with various types of cancer.

Caution is advised when taking soy supplements, as numerous adverse effects, including an increased risk of drug interactions, are possible. Soy should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Spiritual healing: Cancer patients, especially those who fear recurrence or are unhappy with their physicians, commonly use prayer and spiritual healing. More research is needed to address the effects of spiritual healing on anxiety, depression, and quality of life in patients with cancer.

Spiritual healing should not be used as the only treatment approach for medical or psychiatric conditions, and it should not delay the time it takes to consider more proven therapies.

Sweet annie: Certain constituents found in sweet annie show promise for use in cancer when used in combination with standard chemotherapy. However, currently there is not enough scientific evidence in humans to make a strong recommendation for this use.

Avoid if allergic or hypersensitive to sweet annie (Artemisia annua), its constituents, or members of the Asteraceae/Compositae family, such dandelion, goldenrod, ragweed, sunflower, and daisies. Use cautiously in patients who are taking angiogenic agents, or those recovering from surgery or other wounds. Use cautiously in those taking cardiotoxic or neurotoxic agents or those with compromised cardiac or neural function. Use cautiously if taking immunostimulants or quinolines. Avoid if pregnant or breastfeeding.

Thiamin (vitamin B1): Thiamin deficiency has been observed in some cancer patients, possibly due to increased metabolic needs. It is not clear if lowered levels of thiamin in such patients may actually be beneficial. Currently, it remains unclear if thiamin supplementation plays a role in the management of any particular types of cancer.

Thiamin is generally considered safe and relatively nontoxic. Avoid if allergic or hypersensitive to thiamin.
Rare hypersensitivity or allergic reactions have occurred with thiamin supplementation. Skin irritation, burning, or itching may rarely occur at injection sites. Large doses may cause drowsiness or muscle relaxation. Use cautiously if pregnant or breastfeeding.

Thymus extract: Preliminary evidence suggests that thymus extract may increase disease-free survival and immunological improvement in several types of cancer. Additional research is needed in this area.

Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously, due to the potential for exposure to the virus that causes "mad cow disease." Avoid with an organ transplant or other forms of allografts or xenografts. Avoid in those receiving immunosuppressive therapy or hormonal therapy, and those with thymic tumors, myasthenia gravis (a neuromuscular disorder), or untreated hypothyroidism. Avoid if pregnant or breastfeeding.

Traditional Chinese medicine (TCM): The ancient Chinese philosophy of Taoism provided the basis for the development of Chinese medical theory. TCM uses over 120 different herbs in cancer treatment, depending on the type of cancer and its cause according to Chinese medical theory. Studies have reported significant benefits, including reduced tumors, reduced treatment side effects, and improved response to treatment. More studies of stronger design are needed before TCM can be recommended with confidence as an adjunct to cancer treatment, although centuries of traditional use in cancer cannot be discounted.

Chinese herbs can be potent and may interact with other herbs, foods, or drugs. Consult a qualified healthcare professional before taking. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources. Avoid ma huang, which is the active ingredient in ephedra. Avoid ginseng if pregnant or breastfeeding.

Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve stimulation (TENS) is a noninvasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Although TENS has been used with some success in cancer pain, there is not enough reliable evidence to draw a firm conclusion in this area. TENS is often used in combination with acupuncture.

Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.

Turmeric: Turmeric (Curcuma longa) is commonly used for its anti-inflammatory properties. Several early animal and laboratory studies report anticancer (colon, skin, breast) properties of curcumin. Many mechanisms have been considered, including antioxidant activity, antiangiogenesis (prevention of new blood vessel growth), and direct effects on cancer cells. Currently it remains unclear if turmeric or curcumin has a role in preventing or treating human cancer. There are several ongoing studies in this area.

Caution is advised when taking turmeric supplements, as numerous adverse effects, including an increased risk of bleeding and drug interactions, are possible. Turmeric should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.

Vitamin A: Research results are not clear as to whether vitamin A is beneficial in the treatment or prevention of colorectal, esophageal, prostate, or skin cancer. Vitamin A has also been studied as a possible treatment for lung cancer, without evidence of benefit. Available evidence suggests that high-dose vitamin A and beta-carotene may actually increase the risk of adverse effects, especially among alcohol users and smokers.

Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously in those with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may have an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses. Use cautiously if breastfeeding, because the benefits or dangers to nursing infants are not clearly established.

Vitamin B6: There are data supporting the claim that vitamin B6 lowers the risk of colon cancer. Supplementation with a combination of folic acid, vitamin B6, and vitamin B12 did not decrease the risk of breast cancer. There is evidence that male smokers with higher serum levels of pyridoxine may have a lower risk of lung cancer. Well-designed clinical trials are needed to confirm these results, and supplementation is not standard therapy for cancer prevention at this time.

Some individuals seem to be particularly sensitive to vitamin B6 and may have problems at lower doses. Vitamin B6 is likely safe when taken by mouth in doses that do not exceed the recommended dietary allowance (RDA). Avoid excessive dosing. The RDA for pregnant women is 1.9 milligrams daily. There is some concern that high-dose pyridoxine taken by a pregnant mother can cause seizures in a newborn. The RDA in breastfeeding women is two milligrams daily.

Vitamin B12: Researchers at Johns Hopkins University report that women with breast cancer tend to have lower vitamin B12 levels in their blood serum than do women without breast cancer. Higher dietary folate intake is associated with a reduced risk of breast cancer. The risk may be further reduced in women who also consume high amounts of dietary vitamin B12 in combination with dietary pyridoxine (vitamin B6) and methionine. However, there is no evidence that dietary vitamin B12 alone reduces the risk of breast cancer.

Avoid vitamin B12 supplements if allergic or hypersensitive to cobalamin, cobalt, or any other product ingredients. Avoid in those with coronary stents (a mesh tube that holds clogged arteries open) and Leber's disease. Use cautiously in those undergoing angioplasty and those with anemia. Vitamin B12 is generally considered safe when taken in amounts that are not higher than the recommended dietary allowance (RDA). There is not enough scientific data available about the safety of larger amounts of vitamin B12 during pregnancy and/or breastfeeding.

Vitamin C (ascorbic acid): Dietary intake of fruits and vegetables high in vitamin C has been associated with a reduced risk of various types of cancer in population studies (particularly cancers of the mouth, esophagus, stomach, colon, or lung). However, it is not clear that it is specifically the vitamin C in these foods that is beneficial, and vitamin C supplements have not been found to be associated with this protective effect. Experts have recommended increasing dietary consumption of fruits and vegetables high in vitamin C, such as apples; asparagus; berries; broccoli; cabbage; melon (cantaloupe, honeydew, watermelon); cauliflower; citrus fruits (lemons, oranges); fortified breads, grains, and cereal; kale; kiwi; potatoes; spinach; and tomatoes. Vitamin C has a long history of adjunctive use in cancer therapy, and although there have not been any definitive studies using intravenous (or oral) vitamin C, there is evidence that it has benefit in some cases. Better-designed studies are needed to better determine the role of vitamin C in cancer prevention and cancer treatment.

Avoid if allergic or sensitive to vitamin C product ingredients. Vitamin C is generally considered safe in amounts normally found in foods. Vitamin C supplements are also generally considered safe in most individuals if taken in recommended doses. Large doses (greater than two grams) may cause diarrhea and gastrointestinal upset. Avoid high doses of vitamin C in those with glucose 6-phosphate dehydrogenase deficiency, kidney disorders or stones, cirrhosis (inflammation of the liver), gout, or paroxysmal nocturnal hemoglobinuria (a bleeding disorder). Vitamin C intake from food is generally considered safe if pregnant or breastfeeding. It is not clear if vitamin C supplements in doses higher than Dietary Reference Intake recommendations are safe for pregnant or breastfeeding women. Vitamin C is naturally found in breast milk.

Vitamin D: Limited research suggests that synthetic vitamin D analogs may play a role in the treatment of human cancers. However, it remains unclear if vitamin D deficiency raises cancer risk, or if an increased intake of vitamin D is protective against some cancers. Until additional trials are conducted, it is premature to advise the use of regular vitamin D supplementation for cancer prevention, such as in breast cancer or colorectal cancer. There is preliminary evidence based on laboratory and human studies that high-dose vitamin D may be beneficial in the treatment of prostate cancer. This area is under active investigation, but clear evidence of benefit is not yet available.

Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well tolerated in recommended doses; doses higher than recommended may cause toxic effects. Use cautiously in those with hyperparathyroidism (overactive thyroid), kidney disease, sarcoidosis, tuberculosis, and histoplasmosis. Vitamin D is safe in pregnant and breastfeeding women when taken in recommended doses.

Vitamin E: Reliable scientific evidence that vitamin E is effective as a cancer treatment is currently lacking. Vitamin E has been studied for use in bladder cancer, breast cancer, colon cancer, prostate cancer, and stomach cancer. Additional research is needed. At this time, based on the best available scientific evidence, and recent concerns about the safety of vitamin E supplementation, vitamin E cannot be recommended for cancer prevention.

Caution is merited in people undergoing chemotherapy or radiation, because it has been proposed that the use of high-dose antioxidants may actually reduce the anticancer effects of these therapies. This remains an area of controversy, and studies have produced variable results. Patients interested in using high-dose antioxidants such as vitamin E during chemotherapy or radiation should discuss this decision with their medical oncologist or radiation oncologist. Caution is advised when taking vitamin E supplements, as numerous adverse effects, including an increased risk of bleeding and drug interactions, are possible. Avoid if allergic or hypersensitive to vitamin E. Avoid in those with retinitis pigmentosa (loss of peripheral vision). Use cautiously in those with bleeding disorders or those taking blood thinners. Avoid use above the recommended daily level in pregnant women and breastfeeding women.

Fair negative scientific evidence:

Apricot: Available clinical trials on the use of whole apricots for cancer are currently lacking. However, some research has been conducted on "LaetrileT," an alternative cancer drug marketed in Mexico and other countries outside of the United States. LaetrileT is derived from amygdalin, which is found in apricot pits and nuts such as bitter almond. There are multiple animal studies and initial human evidence to suggest that LaetrileT is not beneficial in the treatment of cancer. Based on a phase II trial in 1982, the U.S. National Cancer Institute concluded that LaetrileT is not an effective chemotherapeutic agent. Nonetheless, many people still travel outside the United States to use this therapy.

Multiple cases of cyanide poisoning, including deaths, have been associated with LaetrileT therapy. Avoid if allergic to apricot, its constituents or members of the Rosaceae family, especially the Prunoideae subfamily of plants. Avoid eating excessive amounts of apricot kernels (more than seven grams daily, or more than 10 kernels daily). Use cautiously with diabetes. Use cautiously when taking supplements containing beta-carotene, iron, niacin, potassium, thiamine, or vitamin C. Use cautiously when taking products that may lower blood pressure. Avoid if pregnant or breastfeeding.

Beta-carotene: While diets high in fruits and vegetables rich in beta-carotene have been shown to potentially reduce certain cancer incidences, results from randomized controlled trials with oral supplements do not support this claim.

There is some concern that beta-carotene metabolites with pharmacological activity can accumulate and potentially have carcinogenic (cancer-causing) effects. A higher, statistically significant incidence of lung cancer in male smokers who took beta-carotene supplements has been discovered. Beta-carotene/vitamin A supplements may have an adverse effect on the incidence of lung cancer and on the risk of death in smokers and people exposed to asbestos, or in those who ingest significant amounts of alcohol. In addition, high-dose antioxidants theoretically may interfere with the activity of some chemotherapy drugs or radiation therapy. Therefore, individuals undergoing cancer treatment should speak with their oncologist if they are taking or considering the use of high-dose antioxidants. Beta-carotene in the amounts normally found in food does not appear to have this adverse effect. Avoid if sensitive to beta-carotene, vitamin A, or any other ingredients in beta-carotene products.

Bitter almond: LaetrileT is an alternative cancer drug marketed in Mexico and other countries outside of the United States. Laetrile is derived from amygdalin, which is found in the pits of fruits and nuts such as the bitter almond. Early evidence suggests that LaetrileT is not beneficial in the treatment of cancer. In 1982, the U.S. National Cancer Institute concluded that LaetrileT was not effective for cancer therapy. Nonetheless, many people still travel outside the United States to use this therapy.

Multiple cases of cyanide poisoning, including deaths, have been associated with LaetrileT therapy. Avoid if allergic to almonds or other nuts. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding, because of the risk of birth defects.

Hypnotherapy, hypnosis: Hypnosis did not reduce radiotherapy side effects such as anxiety and did not improve quality of life in patients undergoing curative radiotherapy, in early high-quality studies.

Use cautiously with mental illnesses like psychosis, schizophrenia, manic depression, multiple personality disorder, or dissociative disorders, or with seizure disorders.

Iridology: There is currently limited available data supporting iridology as a tool for cancer diagnosis. Additional research is needed.

Iridology should not be used alone to diagnose disease. Studies of iridology have reported incorrect diagnoses, and thus potentially severe medical problems may go undiagnosed. In addition, research suggests that iridology may lead to inappropriate treatment. Iridology is therefore not recommended as a sole method of diagnosis or treatment for any condition.

Selenium: Results from the Nutritional Prevention of Cancer (NPC) trial, conducted among 1,312 Americans over a 13-year period, suggest that selenium supplementation given to individuals at high risk of nonmelanoma skin cancer is ineffective at preventing basal cell carcinoma and actually increases the risk of squamous cell carcinoma and total nonmelanoma skin cancer. Therefore, selenium supplementation should be avoided in individuals at risk for or with a history of nonmelanoma skin cancer.

Avoid if allergic or sensitive to products containing selenium. Avoid in those with a history of nonmelanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.

Urine therapy: There is insufficient evidence from clinical studies to support the use of urine or urea in the treatment of liver cancer. Additional studies are needed.

Avoid if allergic or hypersensitive to urine or any of its metabolites. Use cautiously in children. Use cautiously if taking medications, especially antidepressants, antipsychotics, or sedative or hypnotic agents. Use cautiously in those with gastrointestinal problems. Avoid in those with urinary tract or kidney infection. Avoid if pregnant or breastfeeding.

Vitamin B12: Preliminary evidence suggests that there is no relationship between vitamin B12 status and lung cancer.

Avoid vitamin B12 supplements if allergic or hypersensitive to cobalamin, cobalt, or any other product ingredients. Avoid in those with coronary stents (mesh tubes that hold clogged arteries open) and Leber's disease. Use cautiously in those undergoing angioplasty and in those with anemia. Vitamin B12 is generally considered safe when taken in amounts that are not higher than the recommended dietary allowance (RDA). There is not enough scientific data available about the safety of larger amounts of vitamin B12 during pregnancy and/or breastfeeding.

Vitamin K: So far, the results from clinical studies are unclear and do not indicate any beneficial effects of vitamin K for hepatocellular carcinoma.

Avoid if allergic or hypersensitive to vitamin K. Injection into the muscle or vein should only be done by a healthcare professional; many serious side effects have occurred after injection. Menadiol (a type of vitamin K that is not available in the United States) should be avoided in those with glucose-6-phosphate dehydrogenase deficiency. Conditions that interfere with absorption of ingested vitamin K may lead to deficiency, including short gut, cystic fibrosis, malabsorption (various causes), pancreas or gallbladder disease, persistent diarrhea, sprue, or ulcerative colitis. Avoid if pregnant. Use cautiously if breastfeeding.

Strong negative scientific evidence:

Folate: Evidence suggests that increased dietary folate intakes or folate status is associated with decreased risk of colorectal or colon cancer. However, folate supplementation studies in general indicate a lack of protective effect for colorectal cancer, with an increased risk found in one meta-analysis. Currently there is insufficient evidence available to suggest folate supplementation for any type of cancer prevention or treatment.

Avoid if allergic or hypersensitive to folate or any folate product ingredients. Use cautiously in those receiving coronary stents and in those with anemia and seizure disorders. It is recommended that pregnant women consume 400 micrograms daily in order to reduce the risk of fetal defects. Folate is likely safe if breastfeeding.

Vitamin A: The overall evidence not only suggests that vitamin A does not reduce the rates of gastric cancer or precancerous gastric lesions but also links vitamin A supplementation with increased mortality.

Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously in those with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may have an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses. Use cautiously if breastfeeding, because the benefits or dangers to nursing infants are not clearly established.

Chemical exposure reduction: Individuals who work with chemicals, such as is the case with hairdressers, printers, and painters should follow all safety instructions to avoid exposure. Individuals with their own well for water may wish to have it tested for contaminants such as lead and arsenic. Local health departments can be a source of water testing.

Exercise and weight control: Controlling weight and exercising regularly can reduce the risk of developing cancer. The American Cancer Society recommends at least 30 minutes of physical activity five or more days per week if the individual can tolerate it.

Fruits, vegetables and whole grains: Fruits, vegetables, and whole grains contain vitamins, minerals, fiber, and antioxidants, which may help protect against developing various types of cancer. Eating five or more servings of fresh fruits and vegetables daily is important for health. A variety of produce should be included in the individual's diet, such as kale, chard, spinach, dark green lettuce, peppers, and squashes.

Limit alcohol consumption: Consuming moderate-to-heavy amounts of alcohol, such as more than one drink daily for women and two for men, may increase the risk of developing certain cancers, such as colon and breast cancer. This is particularly true if the individual has a close relative with cancer, such as a parent, child, or sibling.

Limit fat, especially saturated fat: People who eat high-fat diets may have a higher rate of cancer, such as colon cancer. It is important to limit saturated fats from animal sources such as red meat. Other foods that contain saturated fat include milk, cheese, ice cream, and coconut and palm oils. It is best to restrict the total fat intake to about 30% of daily calories, with no more than 10% coming from saturated fats.

Screening tests: It is best to follow early detection screening guidelines to help find colon, breast, prostate, and other cancers.

Smoking cessation: Smoking can increase the risk of cancers, such as lung and bladder cancers.

Vitamins and minerals: Calcium, magnesium, pyridoxine (vitamin B6), and folic acid may help reduce the risk of colorectal cancer. Good food sources of calcium include skim or low-fat milk and other dairy products, shrimp, and soy products such as tofu and soy milk. Magnesium is found in leafy greens, nuts, peas, and beans. Food sources of vitamin B6 include grains, legumes, peas, spinach, carrots, potatoes, dairy foods, and meat. Folic acid is found in dark leafy greens such as spinach and lettuce, and in legumes, melons, bananas, broccoli, and orange juice.

There are over one hundred types of cancer that can affect the human body. Each of the types of cancer has its own name, behavior, and course of treatment. All cancers involve the abnormal growth of cells. The most commonly found cancers in humans include carcinoma, sarcoma, leukemia, lymphoma, and adenoma.

Carcinoma: More than 85% of cancers are carcinomas. Carcinomas start in the cells that line and cover internal and external organs. The most common carcinomas are lung cancer, breast cancer, skin cancer, and bowel cancer.

Sarcoma: Sarcoma begins in supportive tissues of the body, such as muscle, bone, cartilage, blood vessels, fat, and connective tissue.

Leukemia: Leukemia is cancer of the blood cells that grows in the bone marrow.

Lymphoma: Lymphomas develop in the lymph nodes and tissues of the immune system.

Adenoma: An adenoma is a tumor (usually benign) that begins in glandular tissue, such as the adrenal, pituitary, or thyroid gland.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.